Abstract：
The successful management of infectious keratitis is usually achieved with a combination of tools for accurate diagnosis and targeted timely antimicrobial therapy. An armamentarium of surgical interventions is available in the acute stage which can be resorted to in a step wise manner or in combination guided by the response to treatment. Simple surgical modalities can facilitate accurate diagnosis e.g. corneal biopsy and alcohol delamination. Surgery to promote epithelial healing can vary from tarsorrhaphy, amniotic membrane transplantation or conjunctival flaps depending on the extent of infection, visual prognosis, availability of tissue and surgeon\'s experience. Collagen crosslinking has been increasingly utilized with successful results to strengthen the cornea and reduce the infective load consequently the need for further elaborate surgical interventions. It has shown encouraging results specially in superficial bacterial and fungal keratitis but for deeper infections, viral and acanthamoeba keratitis, its use remains questionable. When globe integrity is compromised, corneal gluing is the most commonly used procedure to seal small perforations. In larger perforations/fulminant infections a tectonic/therapeutic graft is advisable. Partial thickness grafts are increasingly popular to treat superficial infection or internally tamponade perforations. Peripheral therapeutic grafts face challenges with potential requirement for a manually fashioned graft, and increased risk of rejection due to proximity to the limbal vessels. Late stage visual rehabilitation is likely to require further surgical interventions after complete resolution of infection and inflammation. A preliminary assessment of corneal sensation and integrity of the ocular surface are key for any successful surgical intervention to restore vision.
摘要：
感染性角膜炎的成功治疗通常是通过准确诊断和及时靶向抗菌治疗的工具组合来实现的。在急性期可以使用外科手术器械，可以通过对治疗的反应以逐步方式或组合方式进行。简单的手术方式可以促进准确的诊断，例如角膜活检和酒精分层。促进上皮愈合的手术可能与tarsorrhy不同，羊膜移植或结膜瓣取决于感染的程度，视觉预后，组织和外科医生的经验的可用性。已经越来越多地利用胶原交联以成功的结果来增强角膜并减少感染负荷,因此需要进一步精细的手术干预。它已显示出令人鼓舞的结果，特别是在浅表细菌和真菌性角膜炎，但对于更深的感染，病毒性和棘阿米巴角膜炎，它的使用仍然值得怀疑。当全球完整性受损时，角膜胶合是最常用的密封小穿孔的方法。在较大的穿孔/暴发性感染中，建议使用构造/治疗性移植物。部分厚度移植物越来越多地用于治疗浅表感染或内部填塞穿孔。外周治疗性移植物面临着对手动成型移植物的潜在需求的挑战，以及由于靠近角膜缘血管而导致排斥反应的风险增加。后期视觉康复可能需要在感染和炎症完全消退后进行进一步的手术干预。对角膜感觉和眼表完整性的初步评估是任何成功的手术干预以恢复视力的关键。
