Efficacy of corneal limbal stem cell transplantation in the treatment of fungal corneal ulcers and its effect on the microbiome
Purpose To evaluate the clinical efficacy of limbal stem cell transplantation(LSCT)in the treatment of fungal corneal ulcers and explore its impact on the corneal microbiome.Methods This study was a controlled trial.A total of 100 patients with fungal corneal ulcers were included and divided into a LSCT treatment group and a standard antifungal drug treatment group(control group),with 50 cases in each group.The main efficacy evaluation indicators include corneal ulcer healing,visual recovery,improvement of corneal inflammatory response,and changes in the corneal microbiome.Patients underwent detailed eye examinations before treatment(baseline)and at weeks 1,2,4,and 8 after treatment,and the microbial community structure was analyzed by 16S rRNA gene sequencing.Results The LSCT group showed significantly better efficacy than the control group at each time point.In the 1st week of treatment,the corneal ulcer area in the LSCT group was significantly reduced(4.50±1.16 mm2 vs 5.78±1.30 mm2,t=-5.268,P＜0.01),and was almost completely healed by the 8 th week(0.18±0.29 mm2 vs 1.52±0.88 mm2,t=-9.414,P＜0.01).In terms of visual acuity recovery,UCVA in the LSCT group improved to 0.31±0.17 LogMAR at the 8th week,compared with 0.62±0.28 LogMAR in the control group(t=-6.934,P＜0.01);BCVA in the LSCT group was 0.21±0.12 LogMAR,compared with 0.41 in the control group.0.18 LogMAR(t=-6.233,P＜0.01).The improvement of corneal inflammatory response was also significantly better than that of the control group.The anterior chamber inflammatory cell count in the LSCT group dropped to 0.32±0.29 cells/high power field at the 8th week,compared with 1.00±0.46 cells/high power field in the control group(t=-8.186,P＜0.01).Microbiome analysis showed that the Shannon index of the LSCT group increased significantly at week 8(5.37±0.51 vs 4.23±0.60,t=10.059,P＜0.01),and the relative abundance of Staphylococcusepidermidis and Propionibacteriumacnes was associated with corneal ulcer healing and There was a significant positive correlation with visual acuity recovery(Spearman r was 0.432 and 0.356 respectively,P＜0.05).Conclusion Limbal stem cell transplantation shows significant efficacy in the treatment of fungal corneal ulcers.It can accelerate the healing of corneal ulcers,improve visual recovery,and effectively reduce corneal inflammatory reactions.
NETL
NSTL
万方数据
