Cataract Surgery in Eyes with Congenital Iris-Choroidal Coloboma: Quantitative Assessment of Intraocular Lens Alignment and Optical Quality.

Background/

Objectives

Cataract surgery in eyes with congenital iris-choroidal coloboma is technically challenging, and postoperative intraocular lens (IOL) alignment and objective optical quality remain insufficiently characterized. This study evaluated short-term surgical outcomes, early postoperative IOL alignment, and objective optical quality after phacoemulsification with IOL implantation in eyes with congenital iris-choroidal coloboma and cataract.

Methods

This retrospective comparative study included 36 eyes with congenital iris-choroidal coloboma complicated by cataract and 31 eyes with age-related cataract. All eyes underwent phacoemulsification with in-the-bag monofocal IOL implantation. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), early postoperative IOL tilt and decentration, and objective optical quality parameters, including modulation transfer function (MTF) and Strehl ratio (SR), were evaluated 1 month postoperatively. Multivariable linear regression analyses were performed to identify factors associated with postoperative BCVA and IOL tilt in coloboma eyes.

Results

BCVA improved significantly after surgery in coloboma eyes (p < 0.001), although postoperative BCVA remained worse than that in age-related cataract eyes after adjustment for age (p < 0.001). IOP showed no statistically significant change in either group. Coloboma eyes exhibited greater IOL tilt and decentration than age-related cataract eyes (7.60 vs. 4.10° and 0.40 vs. 0.14 mm, respectively; age-adjusted p < 0.001 and p = 0.004), with lower MTF and SR (among eyes with evaluable aberrometry, 17 coloboma eyes and 30 age-related cataract eyes, all p < 0.001). Macular and/or optic disc involvement was associated with worse postoperative BCVA and greater postoperative IOL tilt.

Conclusions

Phacoemulsification with IOL implantation was associated with short-term visual acuity improvement in eyes with congenital iris-choroidal coloboma. These eyes showed greater early postoperative IOL tilt and decentration than age-related cataract eyes, while the evaluable subgroup showed poorer objective optical quality. Macular and/or optic-disc involvement was associated with worse postoperative BCVA and greater IOL tilt.