In this chapter, the emerging applications for OCT in real-time, intraoperative diagnostic imaging and visualization of surgical maneuvers is reviewed, focusing on OCT guidance and evaluation of ophthalmic microsurgery. Three different approaches under development for intraoperative OCT are reviewed, including hand-held OCT imaging during pauses in surgery, microscope-integrated OCT for real-time surgical evaluation and guidance, and intraocular forward-imaging OCT probes. Intraoperative OCT provides surgeons with depth, cross-sectional or three-dimensional visualization in addition to the conventional en face surgical field of view for anterior segment, lens and vitreoretinal surgeries, and may facilitate evaluation of surgical procedures. Such advantages may enable OCT as a vital tool during surgical intervention in addition to its well-known diagnostic capabilities.