Browsing by Author "Thapa, Madhu"
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Publication Axenfeld Rieger Syndrome Presenting with Open Angle Glaucoma in an Adult Patient: A Case Report(Nepal Medical Association, 2025) Thapa, Madhu; Gautam, Pragati; Sitaula, SanjeetaAbstract Axenfeld Rieger Syndrome is autosomal dominant genetic condition, which can present with various ocular and non-ocular findings. Anterior segment dysgenesis is the most common ocular finding leading to glaucoma. Non-ocular findings include craniofacial abnormalities, cardiac, dental as well as neurological problems. Mutations in PITX2 and FOXC1 genes have been associated with this condition. FOXC1 mutation causes more ocular findings where as PITX2 mutation has been linked with ocular as well as craniofacial abnormalities. Racial or gender predilection has not been suggested by any literature. Vision loss in these patients is mainly due to uncontrolled glaucoma which needs to be diagnosed and treated urgently.Publication Cataract among Patients with Renal Transplantation in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Thapa, Madhu; Shrestha, Gulshan Bahadur; Gautam, Pragati; Sigdel, Mahesh RajAbstract Introduction: Intensive immunosuppressant therapy after renal transplantation has found to cause systemic and ocular side effects among them is cataracts. Studies on a similar topic have still remained explored in our setting. The aim of the study was to find out the prevalence of cataract among patients with renal transplantation in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients of renal transplantation at tertiary care centres from 1 May 2021 to 31 October 2021. The data was collected after the ethical approval from Institutional Review Committee [Reference number: 397(6-11) e2077/078]. Study proforma recorded the number of patients with cataracts, duration of steroid use, mean age and other comorbidities. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 31 renal transplant patients, 10 (32.26%) (15.80-48.72, 95% Confidence Interval) had cataract. Conclusions: The prevalence of cataract among renal transplantation patients was found to be lower than similar studies done in similar settings.Publication Changes in Corneal Curvature and Astigmatism After Phacoemulsification Surgery(Nepal Health Research Council, 2025) Yadav, Pramod Kumar; Bhatta, Sabitri; Awasthi, Suresh; Joshi, Sagun N; Thapa, Madhu; Joshi, Niraj Dev; Sapkota, Arjun; Shrestha, Gauri SrAbstract: Background: This study aimed to investigate the relationship between anterior corneal curvature and astigmatism before and after phacoemulsification surgery. Methods: A total of 90 eyes from 90 participants who underwent phacoemulsification with a 3.0 mm superior-temporal clear corneal incision were included in this longitudinal study. Each participant underwent a comprehensive ocular examination, including refraction and keratometry readings (k-readings) obtained using an automated keratometer on the IOL Master. Examinations were conducted preoperatively, on the first postoperative day, at one week, and four weeks postoperatively. The four-week postoperative refractive astigmatism was estimated and predicted with preoperative k-readings. Results: The mean preoperative and postoperative refractive astigmatism was -0.74±0.49D and -0.36±0.18D, with a mean difference of -0.38±0.46D (p<0.001). The proportion of with-the-rule (WTR) astigmatism increased significantly at four weeks postoperatively (71.1%) compared to preoperatively (16.7%). Linear regression analysis showed that postoperative refractive astigmatism was not significantly influenced only by preoperative anterior k-readings obtained using the automated keratometer (?=-0.046; p=0.77). Conclusions: A supero-temporal 3.0 mm clear corneal incision has shown stability in minimizing postoperative surgically induced astigmatism (SIA) in phacoemulsification cataract surgery. Postoperatively, posterior corneal curvature changes may attributes to surgically induced astigmatism which may be benefited by toric intraocular lens implantation (IOL) for better visual outcome.Publication Long-Term Effects of Topical Anti-Glaucoma Medications on Conjunctival Cell Morphology by Impression Cytology(Nepal Health Research Council, 2025) Pachhai, Sareena; Thapa, Madhu; Gautam, Pragati; Sharma, NishaAbstract: Background: Glaucoma is a major cause of irreversible blindness worldwide. Reduction of intraocular-pressure (IOP) using topical anti-glaucoma medications remains the mainstay of treatment. However, prolonged use of these medications may induce adverse effects on the ocular surface. Methodology: This cross-sectional observational study, conducted at the B.P. Koirala Lions Centre for Ophthalmic Studies, Maharjgunj Medical Campus from February 2023 to August 2024. Patients of primary open angle glaucoma receiving topical anti-glaucoma medications for at least three months were enrolled. Conjunctival- Impression Cytology samples were obtained and graded according to Nelson’s grading system. Data analysis was done using SPSS version 16. A p-value <0.05 was considered statistically significant. Results: 128 eyes from 128 glaucoma patients were analyzed, including 54 males (42.2%) and 74 females (57.8%), with mean age of 58.16 ± 14.44 years. Patients using prostaglandin-analogues demonstrated 39.3% Grade-2 and 27.3% Grade-3 changes. Duration of medication use exceeding three years was significantly associated with higher Nelson grades (p < 0.05). Older patients, particularly those aged 61–70 years, exhibited greater cytological changes (p = 0.005). A significant positive correlation was observed between duration of medication use and severity of conjunctival changes (r = 0.597, p < 0.001). Males exhibited more severe conjunctival changes than females (p = 0.009). Conclusions: Prostaglandin-analogues showed most severe conjunctival cytological alterations. Longer duration of medication use, advancing age, and male gender were significantly associated with conjunctival changes.Publication Nutritional Status of Children Under Five Years in a Tertiary Care Center: A Cross-Sectional Study(Nepal APF Hospital, 2025) Chand, Bharat; Poudel, Drishti; Shrestha, Anil; Thakuri, Pushpa Chand; Thapa, Madhu; Shahi, AnitaAbstract: Introduction: Malnutrition remains a leading cause of under-five mortality globally and in Nepal, with significant rates of stunting, wasting, and underweight. Despite national progress, child nutrition challenges persist, especially among vulnerable groups in hospital settings. This study assesses the nutritional status of under-five children attending a tertiary care center in Nepal. Methods: This descriptive cross-sectional study was conducted among 260 under-five children attending the Pediatric Department of Nepal APF Hospital, Kathmandu, from February to June 2025 after ethical approval. Data were collected through face-to-face interviews with caregivers and anthropometric measurements. Nutritional status was assessed using WHO standards. Descriptive statistics, chi-square test, and logistic regression were used for analysis. Results: Among 260 children under five years, the overall prevalence of malnutrition was 30%, including 10% stunted, 11.2% wasted, and 15.4% underweight. Malnutrition was significantly associated with the child’s age (p < 0.001), with children below 24 months more likely to be malnourished. Father's education level also showed a significant association (p = 0.005), where lower paternal education correlated with higher malnutrition rates. No significant associations were observed with maternal, environmental, or child-rearing characteristics. Conclusion: The present study found a notable burden of malnutrition among under-five children visiting a tertiary care center in Kathmandu with younger age and father’s education significantly associated with malnutrition. Targeted early-life nutritional interventions and improved parental education can help to improve the nutritional status of under five children.Publication Prediction and Estimation of Postoperative Refractive Error in Phacoemulsification: Using Ultrasound A-Scan and Intra Ocular Lens Master(Nepal Health Research Council, 2024) Bhatta, Sabitri; Joshi, Sagun Narayan; Thapa, Madhu; Awasthi, Suresh; Shrestha, Gauri Shankar; Joshi, Niraj DevBackground: This study aims to predict and estimate the postoperative refractive outcome in participants undergoing phacoemulsification using IOL Master and A-scan biometry. Methods: A cross-sectional study was done where ninety eyes of 90 participants undergone phacoemulsification using SRK/T formula were included in longitudinal research. Each participant underwent axial length (AL) measurement by IOL Master and A-scan, and keratometry reading (k- reading) by manual TOPCON keratometer and automated keratometer on IOL master for IOL power calculation. All the pre-operative measurements between A-scan and IOL master and two keratometers were compared using paired-t tests. The four-week postoperative refractive error was estimated using univariate analysis and its prediction was compared with the ocular biometry parameters using quadratic regression. Results: Preoperative findings were higher for AL and ACD by IOL master and A-scan (0.27±0.14mm; p<0.001, 0.14±0.31mm, p<0.001) respectively. The AL and K-reading were found to be strong predictors of IOL power calculation (? = -1.07; p<0.001, ? = 0.75; p<0.001), respectively. The AL, K-reading were found to be strong predictors for four-week postoperative refractive error (? = -1.563; p = 0.012, ? = 1.052; p = 0.012) where postoperative error was found to be higher (F = 7.521, p<0.001) in A-scan than IOL Master. For K-reading, the two keratometer’s and for AL by A-scan and IOL Master’s level of agreement (95% LoA) was comparable (-0.15 to 0.12mm and -0.01 to 0.54mm). Conclusions: IOL Master is more reliable for ocular biometry and minimizes postoperative refractive error. Keywords: Axial length; intraocular lens power; keratometry-reading; refractive error estimation; postoperative refractive error.