Introduction: Keratoconus (KC), is a bilateral, noninflammatory degenerative disease of the cornea which is characterized by progressive corneal ectasia and loss of visual function. The onset of KC is commonly seen at puberty and affects approximately 1 in 2000 in the general population. Objective: The aim of this study was to assess the clinical profile of keratoconus in the tertiary eye centre in Nepal. Material and methods: It is a retrospective, hospital based, consecutive study from June 2017 to May 2018. A total of 66 patients (114 eyes) were diagnosed cases of Keratoconus presented in Cornea clinic of Tilganga institute of Ophthalmology. Parameters investigated included patients’ demography, keratometric readings, visualacuity and manifest refraction. Classification of keratoconus was based on Amslern-Krumeich grading system (modified). Results: The mean age of subjects was 18.73 (range: 10-65). Male/female distribution was 48 (72.7%) and 18 (27.3%) respectively. 48 (72.7%) had bilateral keratoconus and 18 (27.3%) were unilateral. Mean Uncorrected visual acuity (UCVA) was 0.80 (range: 0.01-1.00), mean visual acuity ( VA) with spectacle correction was 0.47 (range: 0.01-1.00). Mean spherical amount of refractive was –2.17 (range: −0.50 to −17.00D) and mean cylindrical amount of refraction was -2.85 (range: 0.00 to −6.00). Mean spherical equivalent (SE) of refraction was −4.26 (range: −0.50 to −22.50D). Mean flattest keratometric reading (K1) was 49.63 (range: 40.63-76.70D) and mean steepest keratometric reading (K2) was 53.14 (range: 41.63-73.21D). Mean average keratometric reading was 51.43 (range: 41.63-72.10D). Regarding disease severity, 35.68% of subjects were classified as mild keratoconus, 29.73% as moderate keratoconus, 9.73% as advance keratoconus, while 24.86% were found with the severestage of keratoconus. 78.9% of total eyes presented with minimum pachymetry of 401 to 500 mm. Conclusion: Clinical profile of Nepalese keratoconus patients looks similar to that reported earlier worldwide. The condition was found to manifest at a younger age and was more common in males.

Keratoplasty is a modality of treatment for large and leaking corneal perforation in a tertiary center. We report cases of 20and 30-years old men presented in an emergency with history of road traffic accident 1 and 3 days back. Best corrected visual acuity was hand movement in both injured eye. Slit lamp examination of both cases revealed full thickness corneal laceration with Siedel test positive. Both cases underwent corneal laceration repair with resuturing and corneal glue on consecutive days but couldn't seal the leaking wound. Then ultimately both were undergone for tectonic keratoplasty. The final best corrected visual activity of involved eye was 6/36 in case 1 and 6/24 in case 2. Most cases of traumatic corneal perforation undergone urgent corneal repair but sometimes very difficult to seal the wound. In such cases donor cornea tissue may have to be used to maintain integrity of globe and better visual potential.

Moraxella species are gram-negative diplobacilli and are rare cause of bacterial keratitis. We report a case of a 55-year-old woman presented with pain, redness and profound decrease in vision in both eyes for 2 weeks. One month back she had been treated as acute follicular conjunctivitis elsewhere. She had been treated with ofloxacin drops. On examination, she had central oval full-thickness infiltrate with thinning of cornea and hypopyon in both eyes. She had pseudomembrane in the tarsal conjunctiva. Corneal culture, done separately, showed isolation of Moraxella species, which was resistant to fluoroquinolones. She responded to fortified amikacin and ulcer healed with best-corrected vision of 6/24 and 6/18 in right and left eye respectively. Moraxella keratitis can cause severe keratitis. Conjunctivitis may be complicated by keratitis. Antibiotic resistance can cause problem. Bilateral keratitis should be referred promptly to higher centers if not responding well to treatment.

Introduction: This is a case of case of acute gonococcal conjunctivitis in a 2.5 years old female child. Case: A 2.5 years old female child presented with redness, purulent and profuse discharge from left eye with associated upper eyelid swelling. The culture of conjunctival swab revealed Neisseria gonorrhoeae. The child was treated with intravenous antibiotics and fortified medications. Conclusion: Unlike young adults and newborn gonococcal conjunctivitis (GCC), children can have a nonsexual mode of transmission and could be seen in an unusual age group. For the management of the diseases, proper history including sexual abuse history and thorough physical examination is mandatory, which is sometimes difficult in a developing country. Gonococcal conjunctivitis in the toddler group should be kept in consideration.

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