What factors influence your decision to pursue surgical management in cases of infectious keratitis caused by multidrug-resistant pathogens?

I would consider operating sooner rather than later for a keratitis that’s headed in the wrong direction. It’s important to intervene prior to the development of extensive CNV or limbal involvement or corneal perforation for a more controlled, straightforward operation. The exception may be fungal keratitis due to Aspergillus, which may require months of treatment to clear the infection, but a delayed keratoplasty can still be very successful.