Objective: To observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreoretinal surgery for dense vitreous hemorrhage. Methods: In this retrospective case study,24 subjects (14 males, 10 females, mean±standard deviation age 62.3±16.6 years) were recruited from June 2015 to September 2016 at Eye Hospital, Wenzhou Medical University. One eye of each patient received iOCT to evaluate macular architecture after removal of a dense hemorrhage. Results: The etiologies for the vitreous hemorrhages included proliferative diabetic retinopathy (15 eyes), horseshoe
retinal tear (1 eye), retinal vein occlusion with neovascularization (4 eyes), polypoid choroidal vasculopathy(2 eyes), retinal arterial macro aneurysm (1 eye), and neovascularization due to unknown cause (1 eye).iOCT revealed macular edema (8 eyes), epiretinal membrane (2 eyes), macular edema and epiretinal membrane (1 eye), macular atrophy (2 eyes), and lamellar macular hole (1 eye). The iOCT macular findings were not consistent with examination under the operating microscope in six eyes. The differences resulted in intraoperative changes in the surgical management in four of these eyes. None of the patients experienced endophthalmitis associated with iOCT. Conclusions: Morphological changes of the macular area that are difficult to detect under the operating microscope can be observed by iOCT after removal of a dense vitreous hemorrhage. iOCT may help surgeons improve the management of vitreoretinal surgery.