8-year retrospective review of fungal keratitis in St. Petersburg ophthalmology hospitals

Background: fungal keratitis represents a subtype of infectious keratitis and, depending on the region, may be detected with varying incidence. Timely diagnosis and rapid initiation of antifungal therapy are key tactics in the management of this condition. According to global studies, both the incidence and the spectrum of fungal keratitis pathogens are influenced by climatic factors and the economic status of a country. Aim: to describe the clinical and microbiological spectrum of keratomycoses detected over an 8-year period in major ophthalmology hospitals in St. Petersburg. Patients and Methods: this retrospective study analyzes the medical records of 64 patients who received treatment for fungal keratitis at major ophthalmology centers in St. Petersburg from 2015 to 2023. The study assessed the number of patients, their sex and age, and relevant history, informative value of diagnostic confirmation methods. The most commonly used methods of conservative and surgical treatment and clinical outcomes were also evaluated. Results: over the 8-year period, among 64 hospitalized patients diagnosed with fungal keratitis, women predominated (59.4%). The most common risk factors were ocular trauma (24.2%), improper contact lens usage (13.6%), and a history of previous ocular surgeries. The majority of patients were admitted to the hospital one month or more after symptom onset. Upon admission, most patients had low visual acuity (down to 0.02) and normal intraocular pressure. The principal complications observed were corneal ulceration (54.5%) and hypopyon in the anterior chamber (37.9%). Diagnosis was confirmed by culture in 27.3% of cases, by microscopy in 19.7%, and by confocal scanning in 16.7%. The primary causative agents were filamentous fungi (57.4%) and yeast-like fungi (42.6%), with frequent association with Acanthamoeba (25.8%). Treatment most commonly included chlorhexidine, fluconazole, voriconazole, and amphotericin B. Conclusion: fungal keratitis remains a severe disease characterized by a high risk of complications and unsatisfactory outcomes. These are primarily attributable to delayed presentation, diagnostic challenges, the presence of risk factors, and limited access to specialized antifungal agents. The development of early diagnostic methods and improvements in therapeutic approaches remain pressing issues. KEYWORDS: keratitis, keratomycosis, fungal infection, fungal keratitis, mycotic keratitis, infectious keratitis, ophthalmomycosis. FOR CITATION: Boyko E.V., Shchemerov N.V., Vasilyeva N.V., Scriabina E.V., Kasymov F.O., Bogomolova T.S., Bosak I.A., Popov V.Yu., Titov A.V., Trunin E.M., Tatarkin V.V., Zhumabek D.E., Zeibel Е., Sidina A.S., Tomazova V.S. 8-year retrospective review of fungal keratitis in St. Petersburg ophthalmology hospitals. Russian Journal of Clinical Ophthalmology. 2025;25(3):160–168 (in Russ.). DOI: 10.32364/2311- 7729-2025-25-3-1