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Ex Vivo OCT-Based Multimodal Imaging of Human Donor Eyes for Research into Age-Related Macular Degeneration
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Cortico-retinal decoupling in anisometropic amblyopia: OCTA-VEP multimodal biomarkers reveal neurovascular mismatch
Xindan Meng1, Qing Wang1, Yixia Zhang2
1Department of Ophthalmology, Nanping Aier Eye Hospital, Chongqing, 400060, China.
Background:
To investigate the retinal microcirculation changes in children with anisometropic amblyopia through multimodal assessment and explore its correlation with neurophysiological dysfunction.
Methods:
This prospective cross-sectional study recruited 68 treatment-naïve children (aged 4-14 years) with primary monocular anisometropic amblyopia. The fellow healthy eye served as the control. Macular microvascular parameters, including foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) perfusion density, were quantified using optical coherence tomography angiography (OCTA). Pattern visual evoked potentials (P-VEP) assessed P100 latency and amplitude. Central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were measured. Correlations and multiple linear regression analyses were performed to identify predictors of best-corrected visual acuity (BCVA) in amblyopic eyes.
Results:
Compared to fellow eyes, amblyopic eyes exhibited significant microcirculatory impairment: reduced SCP perfusion density (central: 0.27 vs. 0.29, P < 0.001; full: 0.44 vs. 0.46, P < 0.05), enlarged FAZ area (0.30 vs. 0.26 mm², P = 0.035), and increased CMT (141.00 vs. 131.50 μm, P < 0.05) and RNFL thickness (113.00 vs. 110.00 μm, P < 0.001). P-VEP revealed prolonged P100 latency (119.0 vs. 109.5 ms, P < 0.001) and decreased amplitude (12.8 vs. 19.25 µV, P < 0.001). SCP perfusion density correlated negatively with P100 latency (ρ=-0.341, P = 0.004), and SCP vessel density correlated negatively with CMT (ρ=-0.363, P = 0.002) and FAZ area (ρ=-0.424, P < 0.001). Multiple linear regression analysis (adjusted R²=0.625, P < 0.001) identified RNFL thickness (β = -0.546, P < 0.001) as a significant negative predictor of BCVA (logMAR), while SCP full perfusion density (β = 0.375, P < 0.001) and axial length (β = 0.237, P = 0.007) were significant positive predictors.
Conclusion:
Anisometropic amblyopia is marked by a neurovascular mismatch, manifested through simultaneous retinal hypoperfusion, paradoxical thickening of structures, and delayed neural conduction. The combined OCTA-P-VEP assessment provides a comprehensive biomarker framework. RNFL thickness, SCP perfusion density, and axial length emerge as key independent predictors of visual acuity, suggesting complex interplays between structure, perfusion, and function.
