Superficial Retinal Vascular Network Morphology and Sectoral RNFL Thickness in Children with a History of Bilateral Congenital Cataract Surgery: An Exploratory OCT/OCTA Study.

Background: Whether congenital cataract-related visual deprivation and subsequent rehabilitation are associated with retinal structural and vascular network differences remains unclear. This study evaluated superficial retinal vascular network descriptors and retinal nerve fiber layer (RNFL) thickness in children after bilateral congenital cataract extraction and secondary intraocular lens implantation. Methods: Age-matched children served as controls. Participants underwent spectral-domain optical coherence tomography (OCT) and 6 × 6 mm optical coherence tomography angiography (OCTA). Metrics were magnification-corrected, and comparisons used generalized estimating equation models adjusted for age, eye side, axial length, and spherical equivalent. Results: Eighteen pseudophakic children (36 eyes; median age, 8 years) and 17 controls (34 eyes; median age, 9 years) were included. In adjusted models, macular mean vessel diameter was higher in pseudophakic eyes (β = 11.16 µm; p = 0.003), as was macular mean tortuosity (β = 0.032; p = 0.001). Branchpoint density was lower in direction but not independently significant (p = 0.125). Choroidal thickness, choroidal vascularity index, and foveal avascular zone area did not differ significantly. Temporal RNFL thickness was greater in pseudophakic eyes (β = 13.37 µm; p = 0.007); other RNFL parameters were not significant. Conclusions: These findings suggest exploratory differences in superficial vascular network morphology and temporal RNFL thickness. However, because the groups differed clinically in best-corrected visual acuity, refractive status, and axial length, residual confounding cannot be excluded despite magnification correction and adjusted modeling.