The intra-operative OCT scan is a rarity in ophthalmic operating rooms because of its cost which can add $60,000 to $100,000 to the cost of the surgical microscope. Our facility was fortunate to purchase a new surgical microscope two years ago with the added intra-operative OCT scanner. This allows us to get real-time, high resolution images during the surgery and we have found it particularly useful for looking at phaco incisions as well as lamellar corneal transplants. We have also used it for unusual cases such as this baby with congenital leukocoria. Our vitreo-retinal colleagues have also found the OCT useful in highlighting macular disease such as epi-retinal membranes. The OCT scan is also helpful for teaching the nuances of phaco incisions to our resident surgeons in training. The ability to see the incision architecture in such great detail is useful to hone our techniques to produce exactly the structure we desire.