Purpose: This study evaluates the effectiveness of therapeutic keratoplasty for Fusarium fungal keratitis and explores the diagnosis and management challenges of this infectious corneal disease. Methods: We retrospectively analyzed therapeutic keratoplasty cases at a tertiary hospital for Fusarium keratitis when standard treatments failed. Results: Five cases of Fusarium keratitis, unresponsive to typical antifungal treatments, required keratoplasty due to fast progression and diagnostic difficulties. Post-surgery, all patients had infection resolution without recurrence, but some complications like anterior chamber leakage, graft rejection, and ocular hypertension were managed effectively. Final visual acuity ranged from 0.9 to finger counting. Conclusions: Fusarium keratitis, often resistant to conventional therapies, may necessitate keratoplasty for resolution. This intervention is crucial for positive outcomes, emphasizing the need for prompt and effective management to prevent severe surgical measures and preserve ocular health.