BACKGROUND AND OBJECTIVE: A retrospective, single-center case-series was initiated to evaluate initial clinical experience with the first commercially available intraoperative optical coherence tomography system (iOCT). PATIENTS AND METHODS: The Rescan 700 iOCT (Zeiss, Oberkochen, Germany), a spectral-domain OCT system integrated into a surgical microscope, was used in 40 consecutive cases. A standardized review was used to assess whether iOCT imaging resulted in additional information and/or altered decision-making. RESULTS: The iOCT system was usable in conjunction with common chromovitrectomy dyes and tamponades. The surgeons reported that iOCT imaging provided additional information in 74.1% of the posterior and combined surgical cases, which resulted in altered decision-making in 41.9% of the cases. The iOCT imaging time, on average, amounted to 167 seconds. In anterior procedures, the surgeons reported gaining additional information in 22.2% of all cases, but no cases of altered decision-making were reported. Hereby, the iOCT imaging time amounted to 117 seconds, on average. CONCLUSION: The demonstrated results suggest iOCT has the potential to improve the quality of posterior and anterior segment surgery.