Purpose <p>This study aimed to compare corneal aberrations and anterior segment parameters in preterm children, aged 4–8 years, with or without a history of retinopathy of prematurity (ROP).</p> Methods <p>A comparative cohort study was conducted using corneal tomography to analyse anterior segment parameters in preterm children. Four groups of children were included (<i>n</i> = 30 in each group): children with a history of ROP who were treated with intravitreal bevacizumab, children whose ROP regressed spontaneously and received no treatment, preterm children without ROP and age- and gender-matched full-term children.</p> Results <p>A total of 120 eyes from 120 children with a mean age of 6.63 ± 1.25 years were analysed. Mean anterior corneal curvature was significantly steeper in the treated ROP, spontaneously regressed ROP and preterm (no ROP) groups compared with full-term children (<i>p</i> &lt; 0.001, <i>p</i> = 0.001 and <i>p</i> = 0.04, respectively). Similarly, posterior corneal curvature was steeper in these same groups compared with full-term children (<i>p</i> &lt; 0.001, <i>p</i> &lt; 0.001 and <i>p</i> = 0.007, respectively). Further, the treated and spontaneously regressed ROP groups exhibited narrower iridocorneal angles compared with full-term children (<i>p</i> = 0.02 and <i>p</i> = 0.002, respectively). Higher order aberrations of the anterior cornea and trefoil of the total cornea were elevated in the treated ROP group compared with preterm children (both <i>p</i> = 0.02). Posterior spherical aberration was significantly higher in the spontaneously regressed ROP group compared with full-term controls (<i>p</i> = 0.02).</p> Conclusion <p>Preterm children, regardless of their ROP status, demonstrated steeper anterior and posterior corneal curvatures than full-term children. Children with a history of ROP also exhibited narrower iridocorneal angles and increased corneal aberrations.</p>