Corneal higher-order aberration agreement among Pentacam HR, ACE, and iTrace in primary congenital glaucoma

To evaluate anterior corneal higher-order aberrations (HOAs) and inter-device agreement among Pentacam HR, ACE, and iTrace in primary congenital glaucoma (PCG). This cross-sectional study evaluated 37 eyes of 23 treated PCG patients at 3-, 4-, and 5-mm optical zones. Agreement was assessed with pairwise intraclass correlation coefficients (ICC) and Bland-Altman analysis, using patient-level cluster-bootstrap confidence intervals and distribution-free limits of agreement. Mean age was 9.4 ± 2.8 years. Coma agreement ranged from poor to excellent (ICC 0.34–0.91), improving at larger zones for Pentacam HR–ACE; trefoil agreement was poor for most pairs (ICC ≤ 0.47). Keratometric agreement was excellent for Pentacam HR–ACE (ICC ≥ 0.93) and, after excluding one implausible iTrace acquisition, good to excellent for both iTrace comparisons (ICC 0.88–0.92; n = 21–22 eyes). Restricting to pupil-adequate eyes improved Pentacam HR–ACE horizontal coma agreement at 3 mm (ICC 0.34→0.83; overlapping confidence intervals), suggesting undilated pupil size partly explains disagreement. In this exploratory analysis, the devices did not demonstrate interchangeable performance in PCG eyes. Coma agreed best, though its clinical acceptability is uncertain. Inferential conclusions are limited to Pentacam HR versus ACE at 4–5 mm; ACE at 3 mm and all iTrace comparisons are descriptive. Larger-cohort validation is warranted.