Longitudinal Visual Recovery and Exploratory Neuroimaging Findings in Pediatric Deprivation Amblyopia Following Unilateral Congenital Cataract Extraction: A Prospective Cohort Study

Objectives: Visual outcomes after unilateral congenital cataract (UCC) extraction remain variable, and the neuroanatomical changes accompanying subsequent visual improvement are poorly understood. This study characterized longitudinal changes in visual function and explored hemispheric asymmetry, longitudinal neuroimaging changes, and their associations with visual recovery in children after UCC extraction. Methods: This prospective observational cohort study enrolled 55 children aged 5 to <9 years with unilateral deprivation amblyopia receiving optical correction, passive occlusion, and dichoptic training. We analyzed 6-month changes in central visual field (CVF; mean sensitivity [MS], mean defect [MD]) and corrected distance visual acuity (CDVA). To assess structural alterations along the posterior visual pathways, a strictly controlled, exploratory subgroup of 18 right-handed patients (aged 5 to <8 years) with left-eye amblyopia underwent 3-Tesla (3T) MRI. Multiple comparisons in the neuroimaging and structure–function analyses were controlled using the Benjamini–Hochberg false discovery rate (FDR) procedure. Results: At 6 months, CDVA and CVF improved significantly from baseline across all amblyopia severity groups (all p < 0.05). Greater CDVA improvement was associated with larger increases in MS (β = 3.36, 95% CI, 1.37 to 5.35; p = 0.001) and greater reductions in MD (β = −2.80, 95% CI, −4.82 to −0.79; p = 0.007). Exploratory longitudinal neuroimaging analyses showed decreases in ipsilateral secondary visual cortex (V2) volume (Cohen’s d = −0.75, PFDR = 0.042) and cortical thickness (Cohen’s d = −0.77, PFDR = 0.042). Interhemispheric differences in V2 and middle temporal visual area (MT) cortical thickness were also observed at the 6-month follow-up (all |Cohen’s d| > 0.75, PFDR < 0.05). Nominal structure–function associations were observed for CVF and CDVA changes (all |r| > 0.54, all p < 0.05). No serious adverse events were observed. Conclusions: Children with unilateral deprivation amblyopia following UCC extraction showed improvements in CDVA and CVF over 6 months of routine care. CVF perimetry may provide complementary functional information during longitudinal assessment. Exploratory neuroimaging findings suggested potentially distinct structural correlates of CDVA and CVF recovery, requiring validation in larger controlled longitudinal studies to clarify the clinical significance of CVF and its associated neuroimaging changes.