Introduction: Corneal infection is one of the major causes of monocular blindness in developing countries.

Astigmatism is the commonest type of refractive error among the children of age 5 - 15 years followed by hypermetropia and myopia. Refractive error remains uncorrected in a significant number of children.

Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

Summary We evaluated the diagnostic accuracy of slit-lamp photographs interpreted by telemedicine compared with a conventional clinical examination. A convenience sample of 21 patients with anterior segment disease was enrolled at the Lumbini Eye Institute (LEI) in Bhairahawa, Nepal. An ophthalmologist at the LEI examined each patient and assigned a diagnosis and follow-up interval; this represented the gold standard. An ophthalmic technician then obtained anterior segment photographs of each patient. Slit-lamp photographs and clinical histories were then uploaded to a server for access by three separate readers. These readers, one in Nepal and two in the US, provided a diagnosis and follow-up interval independently. The diagnostic agreement the examiner and all readers was good (kappa=0.75, P<0.0001). The agreement about the follow-up interval between the examiner and all readers was fair, with a kappa coefficient of 0.32 (P<0.0001). However, the agreement was high when comparing the examiner with the reviewer in Nepal (kappa=0.90). The agreement was moderate when comparing the two US-based readers (kappa=0.45). In general, the ophthalmologists in Nepal tended to recommend more rapid follow-up than their US-based counterparts. Our results suggest that the transmission of slit-lamp photographs from satellite clinics and eye heath screening camps to the LEI and elsewhere for review and triage is an effective means of identifying anterior segment pathology.

Background: Infective keratitis is the most common corneal pathology in developing countries. Updated knowledge is needed for its control and proper management. Methodology: All cases of presumed microbial keratitis that presented in an 18-month period from October 2013 to March 2015 were enrolled. Data collected were demographic profile, risk factors, clinical features, and organisms isolated and their sensitivities. Results: A total of 602 cases of microbial keratitis were enrolled. Mean age of subjects (598 patients) was 47.9 years with 53.8% male. 64.1% worked in agriculture. 38.3% gave history of trauma followed by history of herpetic eye diseases (17.9%) and topical steroid use (14.2%). A total of 473 who were referred came at an average of 21.5 days of symptoms. 14.9% (n=90) of cases were either perforated or impending to perforate at presentation. 69.6% had infiltrate in the visual axis. A total of 516 (85.7%) underwent diagnostic corneal culture. A total of 256 (49.6%) yielded a positive result. Pure bacterial growth was seen in 111 (43.4%), pure fungal growth in 138 (53.9%), and mixed microbial growth was present in 7 (2.7%) cases. Out of 121 bacterial isolates, 95.0% were Gram positive. Streptococcus pneumoniae (45.5%, n=55) was the most common bacterial isolate followed by Staphylococcus aureus (20.6%, n=25). Out of 145 fungal isolates, Aspergillus and Fusarium species were found in equal numbers (n=41, 28.3% each). Over 85% of Grampositive organisms isolated in the study were sensitive to vancomycin, cefazolin, moxifloxacin, and gatifloxacin. Over 80% of Gram-negative organisms were sensitive to gentamicin, tobramycin, and amikacin. Conclusion: Microbial keratitis and associated risk factors occurring in farmers implies a lack of awareness and prevention programs. Delay in reaching tertiary care is resulting in complicated cases. Training of local health workers for prophylaxis, updated guidelines for treating keratitis, and timely referral to higher centers are all important in a chain to decrease the incidence of microbial keratitis.

BACKGROUND:A pterygium is a wedge shaped fibrovascular growth of conjunctiva that extends onto the cornea. Various surgical techniques are used to treat this condition. Conjunctiva! graft over the bare sclera is one of the techniques

INTRODUCTION: Toxic keratoconjunctivitis is a frequently encountered problem in the subspecialty of cornea. Toxic keratoconjunctivitis can occur as a complication of exposure to various substances. Toxic keratoconjunctivitis due to exposure to many chemicals and medications have been well described in the literature. The present study was carried out to explore the clinical profile of toxic keratoconjunctivitis caused by insect an unknown cause in a tertiary care center in Lumbini zone of western region of Nepal. METHODS: It was a prospective observational study conducted in cornea clinic of Lumbini Eye Institute, Bhairahawa, Nepal from 1 October 2012 to 30 September 2013. Institutional approval and informed consent was taken. All the patients presented with toxic keratoconjunctivitis caused by insect or unknown causes were included in the study. Patients with other known causes of toxic keratoconjunctivitis like drugs, chemicals were excluded from the study. Detail clinical history, general physical examination and meticulous ophthalmological examination were carried out in all the subjects as per predesigned pro-forma. Patients were followed up after 3 days, 1 week and 2 weeks after initial presentation. RESULTS: Total 39 patients with toxic keratoconjunctivitis presented in cornea clinic of Lumbini Eye Institute during the study period were enrolled and analyzed. The mean age of the patients was 38.20±15.44 year ranging from 16-75 years. Male were affected more than female. In our study 33 (84.62%) patients were male and only 6 (15.38%) patients were female. Most of patients presented during the month of April and May. Twenty one (53.85%) of our patients noticed some small insects lodged in the eye. Eighteen (56.15%) patients had history of exposure of foreign body but could not identify it as insect. Most of patients noticed exposure of insect or an unknown object in Night (36, 92.31%) and only 3 (7.69%) patients during day time. Mean duration of illness was 2.13±1.19 days ranging from 1 to 5 days. Right eye and left eye were involved equally. Complete healing of lesions occurred in all the patients CONCLUSION: Toxic keratoconjunctivitis caused by insect or unknown foreign body is a frequently encountered problem seen in summer months in a tertiary care center in Lumbini zone of western region of Nepal. With treatment all the patient had good out come in form of complete healing of ocular lesions. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9573 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 41-44