Dynamics of Anterior Chamber Angle Parameters in Primary and Secondary Pseudophakic Eyes Following Congenital Cataract Surgery

Purpose: To evaluate anterior chamber angle (ACA) parameter changes and their correlation with intraocular pressure (IOP) in primary versus secondary intraocular lens (IOL) implantation following congenital cataract (CC) surgery, using swept-source anterior segment optical coherence tomography (SS-ASOCT). Methods: Preoperative and postoperative (1 and 6 months) SS-ASOCT images from 89 eyes of 64 patients undergoing CC surgery were analyzed. ACA parameters (AOD500, ARA500, TISA500, TIA500) were measured. Generalized estimating equations assessed ACA parameter changes, and multivariable analysis determined relationships between ACA parameters and IOP. Results: Compared to normal eyes, aphakic eyes showed larger AOD500 and ARA500 but smaller TISA500 (P < 0.05). After IOL implantation, both primary and secondary pseudophakic eyes (P-PsE and S-PsE) exhibited significant postoperative reductions in ARA500 and TISA500 (P < 0.05), mainly in the nasal angle. Multivariable analysis revealed corneal thickness positively correlated with IOP in both groups, while nasal AOD500 (β = -0.685, P < 0.05) and nasal TIA500 (β = -0.109; P < 0.001) showed negative associations in S-PsE. Angle abnormalities were identified during the annotation of images, associated with poorer visual outcomes. Conclusions: Significant postoperative reductions in ARA500 and TISA500 occurred in both primary and secondary IOL implantation for CC, predominantly in the nasal angle. Although overall angle parameters were comparable, S-PsEs uniquely demonstrated IOP correlations with pupil diameter and nasal angle, suggesting distinct IOP regulation mechanisms. Translational Relevance: SS-ASOCT-derived nasal anterior chamber angle metrics may provide an accessible biomarker for monitoring angle remodeling and intraocular pressure regulation following congenital cataract surgery.