Altered anterior segment biometrics in cataract patients with retinitis pigmentosa: a propensity-matched analysis suggests patterns of zonular weakness

Purpose To explore the spatial structure of the anterior segment biometrics in cataract patients with retinitis pigmentosa (RP). Methods This is a retrospective study. We conducted a propensity score matching analysis (1:3) on anterior segment data of RP patients and normal cataract patients who underwent cataract surgery from August 2023 to February 2025. Baseline variables (age, gender, axial length, and Pentacam Nucleus Staging (PNS) score) were balanced to compare the differences in anterior segment biometric measurements between the two groups. Results We analyzed the anterior segment data of 37 cataract patients with RP and 102 simple cataract patients. The RP group exhibited a thicker lens ( p < 0.001), a more anterior lens position ( p = 0.003), a shallower anterior chamber depth ( p < 0.001), and greater corneal astigmatism ( p < 0.001). The shallower anterior chamber depth showed a positive correlation with a more anterior lens position ( r = 0.84, p < 0.001) and the relative lens position ( r = 0.59, p < 0.001). Discussions RP patients exhibit a thicker lens, a more anteriorly positioned lens, shallower anterior chamber depth, and greater corneal astigmatism. These changes can be explained by zonular weakness. Decision-making surrounding intraocular lens selection in eyes with RP, cataract, and zonular compromise may be enhanced through proper identification of preoperative biometric irregularities in the anterior segment.