Mechano-Vascular Remodeling in Duane Retraction Syndrome: OCTA Reveals Superficial Hyperperfusion with Deep Layer Hypoperfusion

Purpose: To compare macular vessel density (VD) between Duane retraction syndrome (DRS) patients and healthy controls using optical coherence tomography angiography (OCTA). Methods: Age- and sex-matched DRS patients and healthy controls were included. Three consecutive OCTA measurements were taken using a Driton device (Topcon, Japan). VD in the central, nasal, temporal, inferior, and superior quadrants of the superficial (SCP), deep (DCP), outer retina (OR), and choriocapillaris (CC) layers were recorded and compared between groups. Results: The study included 114 eyes from 64 participants (29 DRS, 35 controls). The groups did not significantly differ in respect of age (p =0.312), axial length (p = 0.068) and sex distribution (p = 0.508). Central quadrant of SCP VD was significantly higher in DRS patients compared to control subjects (22.55 ± 5.9 % vs 21.8 ± 5.2 %, p = 0.031). DCP in inferior quadrant was significantly lower in DRS patients compared to control subjects (45.81 ± 5.7 % vs 48.19 ± 2.6 %, p = 0.011). CC VD in temporal and superior quadrants were significantly lower in DRS patients compared to control subjects (53.32 ± 2.6 % vs 54.21 ± 1.9 %, p = 0.037) and (51.09 ± 3.5 % vs 52.7 ± 2.5 %, p = 0.010) respectively. No significant differences were observed in the OR (p>0.05). Conclusion: The unique ocular motility patterns in DRS appear to significantly influence retinal perfusion dynamics. Our findings demonstrate a distinct vascular redistribution pattern with diminished CC and DCP perfusion contrasting with elevated SCP flow.