ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2021-1-12-19ophthalmology-1430Research ArticleОБЗОРЫREVIEWSПатогенез и клинические особенности течения грибковых кератитов (обзор литературы)Pathogenesis and Clinical Features of Fungal Keratitis (Review)https://orcid.org/0000-0003-1685-3713БельскаяК. И.BelskaiaK. I.

Бельская Ксения Игоревна – клинический ординатор кафедры офтальмологии

ул. Баррикадная, 2/1, стр. 1, 123242, Москва

Belskaia Kseniia I. – resident of the Department of ophthalmology

2/1, b.1, Barrikadnaya str., 123242, Moscow

https://orcid.org/0000-0003-3689-1311ОбрубовА. С.ObrubovA. S.

Обрубов Анатолий Сергеевич кандидат – медицинских наук, врач-офтальмолог офтальмологического отделения № 4 ГБУЗ «Городская клиническая больница им. С.П. Боткина Департамента здравоохранения г. Москвы» Филиал № 1 «Офтальмологическая клиника», доцент кафедры офтальмологии ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации

Мамоновский пер., 7, 123001, Москва, Российская Федерация,

ул. Баррикадная, 2/1, стр. 1, 123242, Москва

Obrubov Anatoly S. – PhD, ophthalmologist City Clinical Hospital named after S.P. Botkin, Branch № 1, Ophthalmological hospital, associate professor of Ophthalmology department Russian Medical Academy of Continuous Professional Education

7, Mamonovskij lane, 123001, Moscow,

2/1, b.1, Barrikadnaya str., 123242, Moscow

as.obrubov@yandex.ruФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской Федерации; ГБУЗ «Городская клиническая больница им. С.П. Боткина Департамента здравоохранения г. Москвы» Филиал № 1 «Офтальмологическая клиника»РоссияRussian Medical Academy of Continuous Professional Education; City Clinical Hospital named after S.P. Botkin, Branch № 1, Ophthalmological hospitalRussian Federation2021030420211811219Copyright © Бельская К.И., Обрубов А.С., 20212021Бельская К.И., Обрубов А.С.Belskaia K.I., Obrubov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/1430

В обзоре литературы представлены сведения, касающиеся патогенеза развития кератитов грибковой этиологии, а также наиболее характерных клинических признаков, которые помогут врачам-офтальмологам заподозрить грибковую этиологию заболевания. В условиях малой доступности и информативности лабораторно-инструментальных методов диагностики анализ анамнеза и клинической картины остается во многом единственной информацией, на которую опирается офтальмолог при постановке диагноза и определении дальнейшей лечебной тактики. Обзор содержит результаты ряда исследований. Отражены стадии развития грибковой инфекции роговицы, которые представлены фазами адгезии, инвазии, морфогенеза и токсигенности. Показано, что наиболее достоверными признаками грибковых кератитов являются: фестончатые зазубренные края дефекта, выступающий, сухой, крошковидный или творожистый структурированный вид инфильтратов и некротических масс, сателлитные, или отсевные, инфильтраты, характерные изменения цвета зоны поражения роговицы. Тяжесть грибкового язвенного дефекта роговицы коррелирует с неблагоприятным прогнозом исхода заболевания. Грибковые кератиты при распространении инфекции могут осложняться развитием грибковой глаукомы со злокачественным течением и эндофтальмитом. Возможны случаи микст-инфекции. Практически ни один из признаков не является патогномоничным для кератомикозов. Однако оценка всех признаков в совокупности может значительно повысить вероятность правильной постановки диагноза. Требуется обучение офтальмологов распознаванию клинических признаков инфекционных кератитов. В то же время необходимо дальнейшее совершенствование и более широкое внедрение современных методов оперативной диагностики этиологических факторов инфекционных кератитов.

In this review we presented the information about pathogenesis of mycotic keratitis and the most characteristic clinical signs that can help ophthalmologists to suspect mycotic etiology. In conditions of poor accessibility and informativeness of laboratory and instrumental diagnostic tests, the analysis of the anamnesis and the clinical signs remain the only information that can be used by a physician while making a diagnosis and choosing treating strategies. This review contains the results of a number of studies. In the review we show the progression phases of cornea mycotic infection, among them adherence, invasion, morphogenesis and toxigenicity. We also reveal that the most characteristic clinical signs of mycotic keratitis are scalloped rough edge of stromal defect, prominent dry crumby or caseous structured view of infiltrates and necrotic masses, satellite infiltrates, certain changes of color of the defected area. Heaviness of mycotic keratitis ulcer defect has a correlation with an unfavourable prognosis for disease. Mycotic keratitis during contagion can be complicated by mycotic glaucoma with a malignant disease course and endophthalmitis. There can be cases with mixed infection. While Almost No clinical sign is pathognomonic for keratomycoses, summing up all the signs can verify the diagnosis. Ophthalmologists need training in the recognition the clinical signs of infectious keratitis. Also new methods of fast diagnostics of infectious keratitis etiology and implementation on a large scale are needed.

грибковый кератитинфекции роговицымикробные кератитыпатогенезFungal keratitiscorneal infectionsmicrobial keratitispathogenesisReferencesBongomin F., Gago S., Oladele R., Denning D. Global and Multi-National Prevalence of Fungal Diseases — Estimate Precision. J Fungi. 2017;3(4):57. DOI: 10.3390/jof3040057Bongomin F., Gago S., Oladele R., Denning D. Global and Multi-National Prevalence of Fungal Diseases — Estimate Precision. J Fungi. 2017;3(4):57. DOI: 10.3390/jof3040057Dalmon C., Porco T., Lietman T., Prajna N., Prajna L., Das M., Kumar J., Mascarenhas J., Margolis T., Whitcher J., Jeng B., Keenan J., Chan M., McLeod S., Acharya N. The Clinical Differentiation of Bacterial and Fungal Keratitis: A Photographic Survey. Invest Ophthalmol Vis Sci. 2012;53:1787. DOI: 10.1167/iovs.11-8478Dalmon C., Porco T., Lietman T., Prajna N., Prajna L., Das M., Kumar J., Mascarenhas J., Margolis T., Whitcher J., Jeng B., Keenan J., Chan M., McLeod S., Acharya N. The Clinical Differentiation of Bacterial and Fungal Keratitis: A Photographic Survey. Invest Ophthalmol Vis Sci. 2012;53:1787. DOI: 10.1167/iovs.11-8478Vemuganti G., Garg P., Gopinathan U., Naduvilath T., John R., Buddi R., Rao G. Evaluation of agent and host factors in progression of mycotic keratitis. Ophthalmology. 2002;109(8):1538–1546. DOI: 10.1016/s0161-6420(02)01088-6Vemuganti G., Garg P., Gopinathan U., Naduvilath T., John R., Buddi R., Rao G. Evaluation of agent and host factors in progression of mycotic keratitis. Ophthalmology. 2002;109(8):1538–1546. DOI: 10.1016/s0161-6420(02)01088-6Keay L., Gower E., Iovieno A., Oechsler R., Alfonso E., Matoba A., Colby K., Tuli S., Hammersmith K., Cavanagh D., Lee S., Irvine J., Stulting R., Mauger T., Schein O. Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001–2007: A Multicenter Study. Ophthalmology. 2011;118(5):920–926. DOI: 10.1016/j.ophtha.2010.09.011Keay L., Gower E., Iovieno A., Oechsler R., Alfonso E., Matoba A., Colby K., Tuli S., Hammersmith K., Cavanagh D., Lee S., Irvine J., Stulting R., Mauger T., Schein O. Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001–2007: A Multicenter Study. Ophthalmology. 2011;118(5):920–926. DOI: 10.1016/j.ophtha.2010.09.011Kalkanci A., Ozdek, S. Ocular Fungal Infections. Current Eye Research. 2010;36(3):179–189. DOI: 10.3109/02713683.2010.533810Kalkanci A., Ozdek, S. Ocular Fungal Infections. Current Eye Research. 2010;36(3):179–189. DOI: 10.3109/02713683.2010.533810Bourcier T., Sauer A., Dory A., Denis J., Sabou M. Fungal keratitis. Journal Français d’Ophtalmologie. 2017;40:307–313. DOI: 10.1016/j.jfo.2017.08.001Bourcier T., Sauer A., Dory A., Denis J., Sabou M. Fungal keratitis. Journal Français d’Ophtalmologie. 2017;40:307–313. DOI: 10.1016/j.jfo.2017.08.001Sudan R., Sharma Y.R. Keratomycosis: Clinical diagnosis, Medical and Surgical Treatment. JK Science. 2003;5(1):3–10.Sudan R., Sharma Y.R. Keratomycosis: Clinical diagnosis, Medical and Surgical Treatment. JK Science. 2003;5(1):3–10.Thomas P.A. Current perspectives on ophthalmic mycoses. Clin Microbiol Rev. 2003;16(4):730–797. DOI: 10.1128/cmr.16.4.730-797.2003Thomas P.A. Current perspectives on ophthalmic mycoses. Clin Microbiol Rev. 2003;16(4):730–797. DOI: 10.1128/cmr.16.4.730-797.2003Hostetter M.K. Adhesins and ligands involved in the interaction of Candida spp. with epithelial and endothelial surfaces. Clin Microbiol Rev. 1994;7:29–42. DOI: 10.1128/cmr.7.1.29Hostetter M.K. Adhesins and ligands involved in the interaction of Candida spp. with epithelial and endothelial surfaces. Clin Microbiol Rev. 1994;7:29–42. DOI: 10.1128/cmr.7.1.29Jones B.R. Principles in the management of Oculomycosis. XXXI Edward Jackson Memorial Lecture, Am J Ophthalmol. 1975;79:719–751. DOI: 10.1016/00029394(75)90730-8Jones B.R. Principles in the management of Oculomycosis. XXXI Edward Jackson Memorial Lecture, Am J Ophthalmol. 1975;79:719–751. DOI: 10.1016/00029394(75)90730-8Kuriakose T., Thomas P.A. Keratomycotic Malignant Glaucoma, Ind. J. Ophthal. 1991;39(3):118–121.Kuriakose T., Thomas P.A. Keratomycotic Malignant Glaucoma, Ind. J. Ophthal. 1991;39(3):118–121.Xie L., Zhong W., Shi W., Sun S. Spectrum of fungal keratitis in north China. Ophthalmology. 2006;113(11):1943–1948. DOI: 10.1016/j.ophtha.2006.05.035Xie L., Zhong W., Shi W., Sun S. Spectrum of fungal keratitis in north China. Ophthalmology. 2006;113(11):1943–1948. DOI: 10.1016/j.ophtha.2006.05.035Monte F.Q., Stadtherr N.M. Reflections on mycotic keratitis based on findings from histopathologically examined specimens. Rev Bras Oftalmol. 2013;72:87–94. DOI: 10.1590/S0034-72802013000200003.Monte F.Q., Stadtherr N.M. Reflections on mycotic keratitis based on findings from histopathologically examined specimens. Rev Bras Oftalmol. 2013;72:87–94. DOI: 10.1590/S0034-72802013000200003.Ng J.K., Fraunfelder F.W., Winthrop K.L. Review and update on the epidemiology, clinical presentation, diagnosis, and treatment of fungal Keratitis. Curr Fungal Infect Rep. 2013;7(4):293–300. DOI: 10.1007/s12281-013-0163-9Ng J.K., Fraunfelder F.W., Winthrop K.L. Review and update on the epidemiology, clinical presentation, diagnosis, and treatment of fungal Keratitis. Curr Fungal Infect Rep. 2013;7(4):293–300. DOI: 10.1007/s12281-013-0163-9Dursun D., Fernandez V., Miller D., Alfonso E.C. Advanced Fusarium keratitis progressing to endophthalmitis. Cornea. 2003;22(4):300–303. DOI: 10.1097/00003226200305000-00004Dursun D., Fernandez V., Miller D., Alfonso E.C. Advanced Fusarium keratitis progressing to endophthalmitis. Cornea. 2003;22(4):300–303. DOI: 10.1097/00003226200305000-00004San-Blas G., Travassos L.R., Fries B.C., Goldman D.L., Casadevall A., Carmona A.K., Barros T.F., Puccia R., Hostetter M.K., Shanks S.G., Copping V.M., Knox Y., Gow N.A.R. Fungal morphogenesis and virulence. Medical Mycology. 2000;38(1):79–86. DOI: 10.1080/714030905San-Blas G., Travassos L.R., Fries B.C., Goldman D.L., Casadevall A., Carmona A.K., Barros T.F., Puccia R., Hostetter M.K., Shanks S.G., Copping V.M., Knox Y., Gow N.A.R. Fungal morphogenesis and virulence. Medical Mycology. 2000;38(1):79–86. DOI: 10.1080/714030905Thomas P.A., Garrison R.G., Jansen T. Intrahyphal hyphae in corneal tissue from a case of keratitis due to Lasiodiplodia theobromae. J Med Vet Mycol. 1991;29(4):263– 267. DOI: 10.1080/02681219180000381Thomas P.A., Garrison R.G., Jansen T. Intrahyphal hyphae in corneal tissue from a case of keratitis due to Lasiodiplodia theobromae. J Med Vet Mycol. 1991;29(4):263– 267. DOI: 10.1080/02681219180000381Thomas P.A., Jansen T., Van Cutsem J., Geraldine P., Jesudasan C.A.N., Sangamitra M.S. Virulence factors of Lasiodiplodia theobromae in fungal keratitis. In: Pasricha JK, editor. Indian ophthalmology today. New Delhi (India): All-India Ophthalmological Society, 1995: 3–4.Thomas P.A., Jansen T., Van Cutsem J., Geraldine P., Jesudasan C.A.N., Sangamitra M.S. Virulence factors of Lasiodiplodia theobromae in fungal keratitis. In: Pasricha JK, editor. Indian ophthalmology today. New Delhi (India): All-India Ophthalmological Society, 1995: 3–4.Mukherjee P.K., Chandra J. biofilm resistance. Drug Resistance Updates. 2004;7(45):301–309. DOI: 10.1016/j.drup.2004.09.002Mukherjee P.K., Chandra J. biofilm resistance. Drug Resistance Updates. 2004;7(45):301–309. DOI: 10.1016/j.drup.2004.09.002Mukherjee P.K., Chandra J., Yu C., Sun Y., Pearlman E., Ghannoum M.A. Characterization of Fusarium keratitis outbreak isolates: contribution of biofilms to antimicrobial resistance and pathogenesis. Invest Ophthalmol Vis Sci. 2012;53:4450– 4457. DOI: 10.1167/iovs.12-9848Mukherjee P.K., Chandra J., Yu C., Sun Y., Pearlman E., Ghannoum M.A. Characterization of Fusarium keratitis outbreak isolates: contribution of biofilms to antimicrobial resistance and pathogenesis. Invest Ophthalmol Vis Sci. 2012;53:4450– 4457. DOI: 10.1167/iovs.12-9848Porter A.J., Lee G.A., Jun A.S. Infectious crystalline keratopathy. Surv Ophthalmol. 2018;63(4):480–499. DOI: 10.1016/j.survophthal.2017.10.008Porter A.J., Lee G.A., Jun A.S. Infectious crystalline keratopathy. Surv Ophthalmol. 2018;63(4):480–499. DOI: 10.1016/j.survophthal.2017.10.008Córdova-Alcántara I.M., Venegas-Cortés D.L., Martínez-Rivera M.Á., Pérez N.O., Rodriguez-Tovar A.V. Biofilm characterization of Fusarium solani keratitis isolate: increased resistance to antifungals and UV light. J Microbiol. 2019;57(6):485–497. DOI: 10.1007/s12275-019-8637-2Córdova-Alcántara I.M., Venegas-Cortés D.L., Martínez-Rivera M.Á., Pérez N.O., Rodriguez-Tovar A.V. Biofilm characterization of Fusarium solani keratitis isolate: increased resistance to antifungals and UV light. J Microbiol. 2019;57(6):485–497. DOI: 10.1007/s12275-019-8637-2Mitchell B.M., Wu T.G., Jackson B.E., Wilhelmus K.R. Candida albicans strain-dependent virulence and Rim13p-mediated filamentation in experimental keratomycosis. Invest. Ophthalmol. Vis. Sci. 2007;48(2):774–780. DOI: 10.1167/iovs.06-0793Mitchell B.M., Wu T.G., Jackson B.E., Wilhelmus K.R. Candida albicans strain-dependent virulence and Rim13p-mediated filamentation in experimental keratomycosis. Invest. Ophthalmol. Vis. Sci. 2007;48(2):774–780. DOI: 10.1167/iovs.06-0793Kiryu H., Yoshida S., Suenaga Y., Asahi M. Invasion and survival ofFusarium solaniin the dexamethasone-treated cornea of rabbits. J Med Vet Mycol. 1991;29:395– 406. DOI: 10.1080/02681219180000631Kiryu H., Yoshida S., Suenaga Y., Asahi M. Invasion and survival ofFusarium solaniin the dexamethasone-treated cornea of rabbits. J Med Vet Mycol. 1991;29:395– 406. DOI: 10.1080/02681219180000631Bourcier T., Sauer А., Dory А. Fungal keratitis. Journal Français d’Ophtalmologie. 2017;40:307–313. DOI: 10.1016/j.jfo.2017.08.001Bourcier T., Sauer А., Dory А. Fungal keratitis. Journal Français d’Ophtalmologie. 2017;40:307–313. DOI: 10.1016/j.jfo.2017.08.001Raza S.K., Mallett A.I., Howell S.A., Thomas P.A. An in vitro study of the sterol content and toxin production of Fusarium isolates from mycotic keratitis. J Med Microbiol 1994;41(3):204–208. DOI: 10.1099/00222615-41-3-204Raza S.K., Mallett A.I., Howell S.A., Thomas P.A. An in vitro study of the sterol content and toxin production of Fusarium isolates from mycotic keratitis. J Med Microbiol 1994;41(3):204–208. DOI: 10.1099/00222615-41-3-204Parrish C.M., O’Day D.M., Hoyle T.C. Spontaneous fungal corneal ulcer as an ocular manifestation of AIDS. Am J Ophthalmol. 1987;104(3):302–303. DOI: 10.1016/0002-9394(87)90423-5Parrish C.M., O’Day D.M., Hoyle T.C. Spontaneous fungal corneal ulcer as an ocular manifestation of AIDS. Am J Ophthalmol. 1987;104(3):302–303. DOI: 10.1016/0002-9394(87)90423-5Katz N.N., Wadud S.A., Ayazuddin M. Corneal ulcer disease in Bangladesh. Ann Ophthalmol. 1983;15(9):834–836.Katz N.N., Wadud S.A., Ayazuddin M. Corneal ulcer disease in Bangladesh. Ann Ophthalmol. 1983;15(9):834–836.Thomas P.A. Mycotic keratitis — an underestimated mycosis. J Med Vet Mycol. 1994;32(4):235–256. DOI: 10.1080/02681219480000321Thomas P.A. Mycotic keratitis — an underestimated mycosis. J Med Vet Mycol. 1994;32(4):235–256. DOI: 10.1080/02681219480000321Nath R., Baruah S., Saikia L., Devi B., Borthakur A.K., Mahanta J. Mycotic corneal ulcers in upper Assam. Indian J. Ophthalmol. 2011;59(5):367–371. DOI: 10.4103/0301-4738.83613Nath R., Baruah S., Saikia L., Devi B., Borthakur A.K., Mahanta J. Mycotic corneal ulcers in upper Assam. Indian J. Ophthalmol. 2011;59(5):367–371. DOI: 10.4103/0301-4738.83613Gopinathan U., Sharma S., Garg P., Rao G.N. Review of epidemiological features, microbiological diagnosis, and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol. 2009; 57(4):273–279. DOI: 10.4103/03014738.53051Gopinathan U., Sharma S., Garg P., Rao G.N. Review of epidemiological features, microbiological diagnosis, and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol. 2009; 57(4):273–279. DOI: 10.4103/03014738.53051Karp C.L., Tuli S.S., Yoo S.H., Vroman D.T., Alfonso E.C., Huang A.H., Pflugfelder S.C., Culbertson W.W. Infectious keratitis after LASIK. Ophthalmology. 2003;110(3):503–510. DOI: 10.1016/s0161-6420(02)01760-8Karp C.L., Tuli S.S., Yoo S.H., Vroman D.T., Alfonso E.C., Huang A.H., Pflugfelder S.C., Culbertson W.W. Infectious keratitis after LASIK. Ophthalmology. 2003;110(3):503–510. DOI: 10.1016/s0161-6420(02)01760-8Sridhar M.S., Gopinathan U., Rao G.N. Fungal keratitis associated with vernal keratoconjunctivitis. Cornea. 2003;22(1):80–81. DOI: 10.1097/00003226-200301000-00020Sridhar M.S., Gopinathan U., Rao G.N. Fungal keratitis associated with vernal keratoconjunctivitis. Cornea. 2003;22(1):80–81. DOI: 10.1097/00003226-200301000-00020Arora R., Gupta D., Goyal J., Kaur R. Voriconazole versus natamycin as primary treatment in fungal corneal ulcers. Clin Experiment Ophthalmol. 2011;39(5):434– 440. DOI: 10.1111/j.1442-9071.2010.02473.xArora R., Gupta D., Goyal J., Kaur R. Voriconazole versus natamycin as primary treatment in fungal corneal ulcers. Clin Experiment Ophthalmol. 2011;39(5):434– 440. DOI: 10.1111/j.1442-9071.2010.02473.xMulgund U.S., Shankar M.R., Kumar C.S.S. Patterns of presentation of fungal keratitis in tertiary care hospital. J Evid Based Med Health. 2017;4(83):4906–4911. DOI: 10.18410/jebmh/2017/978Mulgund U.S., Shankar M.R., Kumar C.S.S. Patterns of presentation of fungal keratitis in tertiary care hospital. J Evid Based Med Health. 2017;4(83):4906–4911. DOI: 10.18410/jebmh/2017/978Malhotra S, Sharma S, Kaur N, Hans C Fungal Keratitis-A Brief Overview. J Ophthalmic Clin Res. 2015;2(3):18–22. DOI: 10.24966/ocr-8887/100018Malhotra S, Sharma S, Kaur N, Hans C Fungal Keratitis-A Brief Overview. J Ophthalmic Clin Res. 2015;2(3):18–22. DOI: 10.24966/ocr-8887/100018Acharya N.R., Srinivasan M., Mascrenhas J., Ravindran M., Rajaraman R., Zegans M., McLeod S., Lietman T.M. The steroid controversy in bacterial keratitis. Arch Ophthalmol. 2009;127(9):1231. DOI: 10.1001/archophthalmol.2009.221Acharya N.R., Srinivasan M., Mascrenhas J., Ravindran M., Rajaraman R., Zegans M., McLeod S., Lietman T.M. The steroid controversy in bacterial keratitis. Arch Ophthalmol. 2009;127(9):1231. DOI: 10.1001/archophthalmol.2009.221Астахов Ю.С., Скрябина Е.В., Коненкова Я.С., Касымов Ф.О., Богомолова Т.С., Пинегина О.Н. Диагностика и лечение грибковых кератитов. Офтальмологические ведомости. 2013;6(2):75–80.Astakhov Yu.S., Skryabina Ye.V., Konenkova Ya.S., Kasymov F.O., Bogomolova T.S., Pinegina O.N. Mycotic keratitis diagnosis and treatment. Ophthalmology journal = Oftal’mologicheskie vedomosti. 2013;6(2):75–80 (In Russ.).Acharya Y., Acharya B., Karki P. Fungal keratitis: study of increasing trend and common determinants. Nepal J Epidemiol. 2017;7(2):685–693. DOI: 10.3126/nje.v7i2.17975Acharya Y., Acharya B., Karki P. Fungal keratitis: study of increasing trend and common determinants. Nepal J Epidemiol. 2017;7(2):685–693. DOI: 10.3126/nje.v7i2.17975Bharathi M.J., Ramakrishnan R., Vasu S., Meenakshi R., Palaniappan R. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol. 2003;51(4):315–321.Bharathi M.J., Ramakrishnan R., Vasu S., Meenakshi R., Palaniappan R. Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol. 2003;51(4):315–321.Srinivasan M. Fungal keratitis. Curr. Opin. Ophthalmol. 2004;15(4):321–327. DOI: 10.1097/00055735-200408000-00008Srinivasan M. Fungal keratitis. Curr. Opin. Ophthalmol. 2004;15(4):321–327. DOI: 10.1097/00055735-200408000-00008Thomas P.A., Leck A.K., Myatt M. Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi. Br J Ophthalmol. 2005;89(12):1554–1558. DOI: 10.1136/bjo.2005.076315Thomas P.A., Leck A.K., Myatt M. Characteristic clinical features as an aid to the diagnosis of suppurative keratitis caused by filamentous fungi. Br J Ophthalmol. 2005;89(12):1554–1558. DOI: 10.1136/bjo.2005.076315Klotz S.A., Penn C.C., Negvesky G.J., Butrus S.I. Fungal and parasitic infections of the eye. Clin Microbiol Rev. 2000;13(4):662–685. DOI: 10.1128/cmr.13.4.662685.2000Klotz S.A., Penn C.C., Negvesky G.J., Butrus S.I. Fungal and parasitic infections of the eye. Clin Microbiol Rev. 2000;13(4):662–685. DOI: 10.1128/cmr.13.4.662685.2000Dunlop A.A., Wright E.D., Howlader S.A., Nazrul I., Husain R., McClellan K., Billson F.A. Suppurative corneal ulceration in Bangladesh: a study of 142 cases, examining the microbiological diagnosis, clinical and epidemiological features of bacterial and fungal keratitis. Aust N Z J Ophthalmol. 1994;22(2):105–110. DOI: 10.1111/j.1442-9071.1994.tb00775.xDunlop A.A., Wright E.D., Howlader S.A., Nazrul I., Husain R., McClellan K., Billson F.A. Suppurative corneal ulceration in Bangladesh: a study of 142 cases, examining the microbiological diagnosis, clinical and epidemiological features of bacterial and fungal keratitis. Aust N Z J Ophthalmol. 1994;22(2):105–110. DOI: 10.1111/j.1442-9071.1994.tb00775.xGajjar DU, Pal AK, Ghodadra BK, Vasavada AR. Microscopic Evaluation, Molecular Identification, Antifungal Susceptibility, and Clinical Outcomes in Fusarium, Aspergillus and, Dematiaceous Keratitis. Biomed Res Int. 2013;2013:605308. DOI: 10.1155/2013/605308Gajjar DU, Pal AK, Ghodadra BK, Vasavada AR. Microscopic Evaluation, Molecular Identification, Antifungal Susceptibility, and Clinical Outcomes in Fusarium, Aspergillus and, Dematiaceous Keratitis. Biomed Res Int. 2013;2013:605308. DOI: 10.1155/2013/605308Hu F., Huang W.J., Huang S.F. Clinicopathologic Study of Satellite Lesions in Nontuberculous Mycobacterial Keratitis. Jpn J Ophthalmol. 1998;42(2):115–118. DOI: 10.1016/s0021-5155(97)00117-2Hu F., Huang W.J., Huang S.F. Clinicopathologic Study of Satellite Lesions in Nontuberculous Mycobacterial Keratitis. Jpn J Ophthalmol. 1998;42(2):115–118. DOI: 10.1016/s0021-5155(97)00117-2Kheir W.J., Sheheitli H., Abdul Fattah M., Hamam R.N. Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature. Biomed Res Int. 2015;2015:164989. DOI: 10.1155/2015/164989Kheir W.J., Sheheitli H., Abdul Fattah M., Hamam R.N. Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature. Biomed Res Int. 2015;2015:164989. DOI: 10.1155/2015/164989Chaurasia S., Muralidhar R., Das S., Vaddavalli P.K., Garg P., Gopinathan U. Pseudomonas keratitis with satellite lesions: an unusual presentation. Br J Ophthalmol. 2010;94(10):1409–1410. DOI: 10.1136/bjo.2009.172171Chaurasia S., Muralidhar R., Das S., Vaddavalli P.K., Garg P., Gopinathan U. Pseudomonas keratitis with satellite lesions: an unusual presentation. Br J Ophthalmol. 2010;94(10):1409–1410. DOI: 10.1136/bjo.2009.172171Филиппенко В.И., Старчак Т.И. Заболевания и повреждения роговицы. — Киев: Здоровье, 1987. С. 50–52.Filippenko V.I., Starchak T.I. Diseases and injuries of the cornea. Kiev: Zdorov’e, 1987. P. 50–52 (In Russ.).Punia R.S., Kundu R., Chander J., Arya SK., Handa U., Mohan H. Spectrum of fungal keratitis: clinicopathologic study of 44 cases. Int J Ophthalmol. 2014;7(1):114– 117. DOI: 10.3980/j.issn.2222-3959.2014.01.21Punia R.S., Kundu R., Chander J., Arya SK., Handa U., Mohan H. Spectrum of fungal keratitis: clinicopathologic study of 44 cases. Int J Ophthalmol. 2014;7(1):114– 117. DOI: 10.3980/j.issn.2222-3959.2014.01.21Rosa R.H. Jr, Miller D., Alfonso E.C. The changing spectrum of fungal keratitis in south Florida. Ophthalmology. 1994;101(6):1005–1013. DOI: 10.1016/s01616420(94)31225-5Rosa R.H. Jr, Miller D., Alfonso E.C. The changing spectrum of fungal keratitis in south Florida. Ophthalmology. 1994;101(6):1005–1013. DOI: 10.1016/s01616420(94)31225-5Thomas P.A. Fungal infections of cornea. Eye. 2003;17(8):852–862. DOI: 10.1038/sj.eye.6700557Thomas P.A. Fungal infections of cornea. Eye. 2003;17(8):852–862. DOI: 10.1038/sj.eye.6700557Sharma S., Srinivasan M., George C. The current status of Fusarium species in mycotic keratitis in South India. J Med Microbiol. 1993;11:140–147.Sharma S., Srinivasan M., George C. The current status of Fusarium species in mycotic keratitis in South India. J Med Microbiol. 1993;11:140–147.Wilhelmus K.R., Jones D.B. Curvularia keratitis. Trans Am Ophthalmol Soc. 2001;99:111–132.Wilhelmus K.R., Jones D.B. Curvularia keratitis. Trans Am Ophthalmol Soc. 2001;99:111–132.Garg P., Gopinathan U., Choudhary K., Rao G.N. Keratomycosis: clinical and microbiologic experience with dematiaceous fungi. Ophthalmology. 2000;107:574– 580. DOI: 10.1016/S0161-6420(99)00079-2Garg P., Gopinathan U., Choudhary K., Rao G.N. Keratomycosis: clinical and microbiologic experience with dematiaceous fungi. Ophthalmology. 2000;107:574– 580. DOI: 10.1016/S0161-6420(99)00079-2Oldenburg C.E., Prajna V.N., Prajna L., Krishnan T., Mascarenhas J., Vaitilingam C.M., Srinivasan M., See C.W., Cevallos V., Zegans M.E., Acharya N.R., Lietman T.M. Clinical signs in dematiaceous and hyaline fungal keratitis. Br J Ophthalmol. 2011;95(5):750–751. DOI: 10.1136/bjo.2010.198648Oldenburg C.E., Prajna V.N., Prajna L., Krishnan T., Mascarenhas J., Vaitilingam C.M., Srinivasan M., See C.W., Cevallos V., Zegans M.E., Acharya N.R., Lietman T.M. Clinical signs in dematiaceous and hyaline fungal keratitis. Br J Ophthalmol. 2011;95(5):750–751. DOI: 10.1136/bjo.2010.198648Guttman C. Diagnostic and therapeutic advances emerging for fungal keratitis. Eurotimes. 2007;12:16.Guttman C. Diagnostic and therapeutic advances emerging for fungal keratitis. Eurotimes. 2007;12:16.Ganegoda N., Rao S.K. Antifungal therapy for keratomycoses. Antifungal therapy for keratomycoses. Expert Opin Pharmacother. 2004;5(4):865–874. DOI: 10.1517/14656566.5.4.865Ganegoda N., Rao S.K. Antifungal therapy for keratomycoses. Antifungal therapy for keratomycoses. Expert Opin Pharmacother. 2004;5(4):865–874. DOI: 10.1517/14656566.5.4.865Xu L.J., Song X.S., Zhao J., Sun S.Y., Xie L.X. Hypopyon in patients with fungal keratitis. Chin Med J (Engl). 2012;125(3):470–475.Xu L.J., Song X.S., Zhao J., Sun S.Y., Xie L.X. Hypopyon in patients with fungal keratitis. Chin Med J (Engl). 2012;125(3):470–475.Shi W., Wang T., Xie L., Li S., Gao H., Liu J., Li H. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation. Ophthalmology. 2010;117(5):890–896. DOI: 10.1016/j.ophtha.2009.10.004Shi W., Wang T., Xie L., Li S., Gao H., Liu J., Li H. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation. Ophthalmology. 2010;117(5):890–896. DOI: 10.1016/j.ophtha.2009.10.004Xie L., Hu J., Shi W. Treatment failure after lamellar keratoplasty for fungal keratitis. Ophthalmology. 2008;115(1):33–36. DOI: 10.1016/j.ophtha.2007.03.072Xie L., Hu J., Shi W. Treatment failure after lamellar keratoplasty for fungal keratitis. Ophthalmology. 2008;115(1):33–36. DOI: 10.1016/j.ophtha.2007.03.072Lalitha P., Prajna N., Kabra A., Mahadevan K., Srinivasan M. Risk Factors for treatment outcome in Fungal Keratitis. Ophthalmology. 2006;113(4):526-530. DOI: 10.1016/j.ophtha.2005.10.063Lalitha P., Prajna N., Kabra A., Mahadevan K., Srinivasan M. Risk Factors for treatment outcome in Fungal Keratitis. Ophthalmology. 2006;113(4):526-530. DOI: 10.1016/j.ophtha.2005.10.063Wallang B.S., Das S., Sharma S., Sahu S.K., Mittal R. Ring Infiltrate in Staphylococcal Keratitis. J Clin Microbiol. 2013;51(1):354–355. DOI: 10.1128/JCM.02191-12Wallang B.S., Das S., Sharma S., Sahu S.K., Mittal R. Ring Infiltrate in Staphylococcal Keratitis. J Clin Microbiol. 2013;51(1):354–355. DOI: 10.1128/JCM.02191-12Mascarenhas J., Lalitha P., Prajna N.V. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Ophthalmol. 2014;157(1):56–62. DOI: 10.1016/j.ajo.2013.08.032Mascarenhas J., Lalitha P., Prajna N.V. Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features. Am J Ophthalmol. 2014;157(1):56–62. DOI: 10.1016/j.ajo.2013.08.032Barash A., Chou T.Y. Moraxella atlantae keratitis presenting with an infectious ring ulcer. Am J Ophthalmol Case Rep. 2017;7:62–65. DOI: 10.1016/j.ajoc.2017.06.003Barash A., Chou T.Y. Moraxella atlantae keratitis presenting with an infectious ring ulcer. Am J Ophthalmol Case Rep. 2017;7:62–65. DOI: 10.1016/j.ajoc.2017.06.003Szentmáry N, Daas L, Shi L, Laurik KL, Lepper S, Milioti G, Seitz B. Acanthamoeba keratitis — Clinical signs, differential diagnosis and treatment. J Curr Ophthalmol. 2019;31(1):16–23. DOI: 10.1016/j.joco.2018.09.008Szentmáry N, Daas L, Shi L, Laurik KL, Lepper S, Milioti G, Seitz B. Acanthamoeba keratitis — Clinical signs, differential diagnosis and treatment. J Curr Ophthalmol. 2019;31(1):16–23. DOI: 10.1016/j.joco.2018.09.008Teichmann K.D., Cameron J., Huaman A., Rahi A.H.S., Badr I. Wessely-type immune ring following phototherapeutic keratectomy. J Cataract Refract Surg. 1996;22(1):142–146. DOI: 10.1016/s0886-3350(96)80284-7Teichmann K.D., Cameron J., Huaman A., Rahi A.H.S., Badr I. Wessely-type immune ring following phototherapeutic keratectomy. J Cataract Refract Surg. 1996;22(1):142–146. DOI: 10.1016/s0886-3350(96)80284-7Lin T.T., Wei R.H., Yang R.B., Huang Y., Zhang C., Ning Y.X., Zhao S.Z. Fungal Keratitis Associated with Viral Keratitis. Chin Med J (Engl). 2015;128(20):2823–2825. DOI: 10.4103/0366-6999.167367Lin T.T., Wei R.H., Yang R.B., Huang Y., Zhang C., Ning Y.X., Zhao S.Z. Fungal Keratitis Associated with Viral Keratitis. Chin Med J (Engl). 2015;128(20):2823–2825. DOI: 10.4103/0366-6999.167367Ahn M., Yoon K.-C., Ryu S.-K., Cho N.-C., You I.-C. Clinical Aspects and Prognosis of Mixed Microbial (Bacterial and Fungal) Keratitis. Cornea, 2011;30(4):409–413. DOI: 10.1097/ico.0b013e3181f23704Ahn M., Yoon K.-C., Ryu S.-K., Cho N.-C., You I.-C. Clinical Aspects and Prognosis of Mixed Microbial (Bacterial and Fungal) Keratitis. Cornea, 2011;30(4):409–413. DOI: 10.1097/ico.0b013e3181f23704

The authors declare that there are no conflicts of interest present.