To compare the demographics and ocular characteristics, including anterior segment optical coherence tomography images and zonular instability, in eyes with a history of acute angle closure (AAC) attack and subsequent cataract surgery.

Retrospective case-control study.

A total of 68 eyes of 56 patients with a history of AAC attack who underwent cataract surgery were enrolled. Fourteen eyes were assigned to the zonular instability (+) group and 54 were assigned to the zonular instability (−) group based on the presence of zonular instability during cataract surgery. The peak intraocular pressure, preoperative spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and lens vault (LV) were measured and compared between 2 groups. Intereye (intraindividual) comparison was also performed. Factors associated with zonular instability were assessed.

In the zonular instability (+) group, 9 eyes were from male and 5 from female participants. Eyes in the zonular instability (+) group showed less hyperopic SE values, longer AL, shallower ACD, and higher LV, as compared with those in the zonular instability (−) group (all P ≤ .001). Moreover, eyes in the zonular instability (+) group had less hyperopic SE, shallower ACD, and higher LV than their fellow eyes. Less hyperopic SE, longer AL, and higher LV were significantly associated with zonular instability on multivariate logistic regression analysis.

Clinicians should consider the possibility of zonular instability during cataract surgery for eyes with less hyperopic SE, longer AL, and higher LV among those with a history of AAC attack.