Altered properties of dynamic functional connectivity and cortical volume of visual cortex after treatment in children with anisometropic amblyopia

To investigate treatment-induced neuroplasticity in anisometropic amblyopia (AA), this study integrated voxel-based morphometry (VBM) and dynamic functional connectivity (dFC) to characterize longitudinal changes in cortical gray matter volume and temporal dynamics of functional connectivity within the visual centers, and to assess their correlations with clinical visual outcomes. Twenty-two children with AA underwent comprehensive ophthalmic assessment, resting-state functional MRI, and 3D-T1WI at baseline and one month post-treatment. We applied VBM to quantify structural changes in visual cortical regions and employed a Hidden Markov Model (HMM) to identify recurrent dFC states. Dynamic temporal properties—including fractional occupancy(FO), mean dwell time(MDT), switching rate (SR), and transition probabilities—were computed for each state. Paired t -tests were used to evaluate pre-post differences in gray matter volume and dFC metrics, and correlation analyses were performed to relate these neural changes to ophthalmic indicators. Following treatment, AA children exhibited increased gray matter volume in the left inferior occipital gyrus and decreased volume in the left middle occipital gyrus. dFC analysis revealed significant reconfiguration in both striate and extrastriate cortices, characterized by increased fractional occupancy and mean dwell time in States 11, and decreased temporal metrics in States 6 and 10. These states were associated with enhanced connectivity between striate and extrastriate regions, despite lower overall functional activity. Key dynamic metrics were correlated with improvements in ophthalmic parameters. Treatment in AA children is associated with structural reorganization and dynamic functional reconfiguration in visual cortices. The observed gray matter volume alterations, along with shifts in dFC state dynamics and strengthened network interactions, suggest that multimodal neuroadaptive processes underpin functional recovery in amblyopia. These findings provide objective imaging-based evidence for the neural mechanisms that support treatment-induced rehabilitation in AA. • First study combining VBM and HMM-based dFC in anisometropic amblyopia. • Treatment induced gray matter volume changes in bilateral occipital gyri. • Dynamic functional connectivity reconfiguration found in visual cortices. • Altered dFC state dynamics correlated with improved visual acuity. • Reveals neuroplastic mechanisms underlying amblyopia treatment recovery.