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Ocular Surface Microbiota Alterations Following FS-LASIK and Their Association With Postoperative Dry Eye
Jingjing Xu1, Chiwen Cheng1, Kang Yu1
1Ophthalmic Center, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China, ncu.edu.cn.
Purpose:
Given the limited evidence on ocular surface microbiota (OSM) changes after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and their link to dry eye (DE), this study aimed to compare microbial profiles in patients with and without postoperative DE, offering a basis for early detection and targeted treatment.
Methods:
Patients undergoing FS-LASIK were evaluated 3 months postoperatively and stratified into DE (N = 30) and non-DE groups (N = 30) based on ocular surface disease index (OSDI), TBUT, and the Schirmer I test. Corneal nerve alterations were assessed using IVCM. Conjunctival sac samples were collected pre- and postoperatively, and microbiota profiles were analyzed via 16S rRNA sequencing.
Results:
Comparative analysis of the OSM revealed significantly higher α-diversity in the DE group compared to the NDE group. At the phylum level, a decrease in Proteobacteria and an increase in Bacteroidetes were observed. At the genus level, Veillonella, Streptococcus, and Aggregatibacter were enriched, whereas Pseudomonas and Lactobacillus were depleted. The abundance of Staphylococcus was positively correlated with OSDI scores and negatively correlated with corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), corneal nerve fiber area (CNFA), and corneal nerve fractal dimension (CFracDim) (all p < 0.05). In contrast, Lactobacillus was positively associated with the Schirmer I test values and corneal nerve fiber density (CNFD) (p < 0.05). At baseline, patients in the DE group exhibited lower abundances of Cyanobacteria and Acinetobacter but higher levels of Verrucomicrobia and Akkermansia. Postoperative within-group comparisons further showed that, relative to baseline, the DE group had increased abundances of Staphylococcus, Veillonella, Ralstonia, and Aggregatibacter, along with decreased levels of Pseudomonas, Corynebacterium, and Helicobacter.
Conclusions:
In summary, dysbiosis between the Staphylococcus and Lactobacillus genera may represent both a biomarker of DE susceptibility and a therapeutic target. Additionally, the preoperative microbial composition may influence postoperative dynamics and DE risk.
Trial Registration:
ClinicalTrials.gov identifier: NCT06448468.
