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To assess the microarchitectural changes occurring during surgery for vitreomacular traction using intraoperative optical coherence tomography (iOCT).A retrospective, consecutive case series of eyes undergoing pars plana vitrectomy for vitreomacular traction with performance of concurrent iOCT. A custom, microscope-mounted portable spectral domain optical coherence tomography system was used. Clinical characteristics and iOCT images were analyzed.Twelve eyes of 12 patients were included with a mean preoperative visual acuity of 20/78 improving to 20/51 (P = 0.02), postoperatively. Intraoperative optical coherence tomography was successfully performed in 100% of cases. Microarchitectural changes were noted on iOCT after surgical release of the vitreomacular traction particularly in the outer retina with increased subretinal hyporeflectivity (e.g., expansion of the distance between the retinal pigment epithelium and photoreceptor layers). In 5 of 12 eyes (42%), iOCT findings altered the surgical procedure (e.g., internal limiting membrane peeling, gas tamponade) to address the subclinical findings (e.g., full-thickness macular hole formation, residual membrane).Intrasurgical imaging using iOCT during vitreomacular traction surgery may identify subclinical changes (e.g., occult full-thickness macular hole formation) that may impact surgical decision making. Architectural changes may occur after surgical maneuvers that are particularly noted in the outer retina. The functional significance of these changes requires further investigation.