OBJECTIVES: This study investigated the effects of the grade of residents, sociodemographic variables, and clinical experience with suicidal patients on the knowledge and attitudes toward suicide among psychiatric residents in Korea. METHODS: A self-reporting survey including 30 questions was conducted together with an investigation of the sociodemographic background of the research subjects. The questionnaire was composed of general knowledge questions on suicide, suicide-related personal experience, attitudes toward suicide, and the treatment experience of suicide attempt patients. Chi-square test and binary logistic regression analysis were used to determine the differences and associations among the attitudes toward suicide, clinical experience of suicide, and sociodemographic characteristics. RESULTS: A significantly higher response rate was presented in the 4th grade on general knowledge of suicide and treatment experience with suicide attempt patients than in the 1st grade. Residents with previous history of psychiatric treatment suicide plans, or attempts presented a significantly higher level of permissive attitude toward suicide. Residents who had a previous history of suicide attempt among their own patients were more likely to think that they were more capable to prevent suicide of patients. CONCLUSION: Effective clinical practices are essential considering the fact that the highest suicide risk groups will inevitably be referred to psychiatric clinical services. The authors expect that the study results regarding suicide-related knowledge, attitudes, and the experience of psychiatric residents will contribute to the development of effective resident training programs for suicide-related clinical practice in Korea.
Cross-Sectional Studies* ; Education ; Humans ; Korea* ; Logistic Models ; Research Subjects ; Suicide

Purpose: We report a rare case of deep vein thrombosis and pulmonary embolism that occurred following 2 weeks in the prone position after a trans pars plana vitrectomy with gas tamponade to treat rhegmatogenous retinal detachment.Case Summary: A 49-year-old man without a remarkable medical history visited our clinic complaining of gradual vision loss on the inferior side of the left eye. In fundus examinations, rhegmatogenous retinal detachment involving the macula with multiple tears was noted. After trans pars plana vitrectomy with gas tamponade, the patient was encouraged to maintain a prone position for retinal reattachment. However, after 2 weeks in the prone position, he complained of right calf pain and swelling. The department of cardiovascular surgery was consulted immediately and deep vein thrombosis and pulmonary embolism were diagnosed. After deep vein thrombectomy and anticoagulation therapy, the lower extremity symptoms improved and the patient was stable during follow-up with a well attached retina. Conclusions When prolonged prone positioning after retina surgery is necessary, careful monitoring for the possibility of deep vein thrombosis and pulmonary embolism is required, especially in high-risk patients.

Purpose: We report successful eyeball-preserving management of a patient with a large choroidal melanoma. We combined partial lamellar sclerouvectomy (PLSU) with ruthenium (Ru)-106 plaque brachytherapy.Case summary: A 48-year-old woman with a history of asthma visited our clinic with a chief complaint of gradual loss of vision at the nasal side of her right eye (best-corrected visual acuity 0.6). Fundus examination revealed a mushroom-shaped, dark choroidal mass 17.1 mm (basal diameter) × 14.2 mm (apical height). There was no evidence of distant metastasis. To remove the tumor while preserving the eyeball, we combined PLSU and simultaneous Ru-106 plaque brachytherapy with the patient under hypotensive general anesthesia. At 6 weeks postoperatively, trans pars plana vitrectomy with silicone oil injection was performed to remove the vitreous hemorrhage and treat the retinal detachment. Intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) (0.05 mL, 1.25 mg) was injected every 2 months to prevent the development of radiation retinopathy. No residual tumor, recurrence, or distant metastasis was noted during follow-up of 2 years. The patient was stable with no ocular complications at her last visit (2 years postoperatively). Conclusions Contrary to what we expected and despite the surgical difficulties, PLSU combined with Ru-106 plaque brachytherapy is a useful eyeball-preserving strategy even when encountering a very large choroidal melanoma (diameter > 16 mm and apical height > 10 mm). Such a melanoma was previously believed to be treatable only via enucleation.

PURPOSE: This study aims to evaluate the cost-effectiveness of two aromatase inhibitors for the adjuvant treatment of women with postmenopausal hormone receptor positive early breast cancer, and to find the most reasonable treatment option when the population is stratified by the nodal status. METHODS: A Markov model was developed with defining six Markov states based on breast cancer progression. The annual probabilities of recurrence by adjuvant treatment (anastrozole, letrozole, and tamoxifen) were estimated from the published studies in the overall population and in the node negative and node positive groups. The costs of the defined breast cancer events were measured by the micro-costing method based on the 2009 National Health Insurance Fee Schedule and the third Clinical Guideline of Breast Cancer Treatment. Anastrozole and letrozole were compared with tamoxifen respectively, using the same Markov model. The incremental cost-effectiveness ratios for the overall population and each subgroup were estimated. RESULTS: Anastrozole was more effective and costly than tamoxifen with anastrozole costing an additional Korean Won (KRW) 22,461,689 per quality-adjusted life year (QALY). Letrozole showed a similar incremental cost of KRW 21,004,142 per QALY. In the node negative group, anastrozole was the most cost-effective with an incremental cost of KRW 19,717,770 per QALY, while letrozole was the most cost-effective with an incremental cost of KRW 8,150,512 per QALY for the node positive group. The sensitivity analysis showed that these results were robust. CONCLUSION: The subgroup analysis clearly demonstrated which treatment was superior among the aromatase inhibitors in terms of the cost-effectiveness. Such a finding was not confirmed for the case of the overall population. The implication of this study is that the decision makers should be careful when generalizing the cost-effectiveness results. The stratified analysis in this context may help reach a reasonable decision for allocating medical resources.
Aromatase Inhibitors ; Breast ; Breast Neoplasms ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Fee Schedules ; Female ; Humans ; National Health Programs ; Nitriles ; Quality-Adjusted Life Years ; Recurrence ; Tamoxifen ; Triazoles

PURPOSE: To compare postoperative clinical outcomes between 2 types of 3-piece aspheric intraocular lenses. METHODS: Uncorrected visual acuity, best corrected visual acuity, total ocular and internal ocular aberration including higher-order aberrations and spherical aberration, and modulation transfer functions were compared 6 months after cataract surgery between eyes implanted with TECNIS ZA9003 (group 1) and HOYA PC-60AD (group 2) in 30 and 28 eyes, respectively, In addition, the differences between postoperative spherical equivalent and preoperative target refractive errors were analyzed. RESULTS: Clinical outcomes showed no significant differences between both groups including visual acuities, high order aberrations, and modulation transfer function. In both groups, postoperative refractive errors were more of a myopic state than preoperative estimated target refraction. The myopic refractive error between both groups showed no significant difference (-0.26 vs. -0.42 diopter, p = 0.75). CONCLUSIONS: The newly developed 3-piece aspheric IOL, HOYA PC-60AD shows similar clinical outcomes compared with the widely used 3-piece IOL TECNIS ZA9003.
Cataract ; Eye ; Lenses, Intraocular ; Refractive Errors ; Visual Acuity

PURPOSE: Our study aimed to determine whether obstructive sleep apnea (OSA) is common among branch retinal vein occlusion (BRVO) patients without systemic risk factors using a Watch PAT-100 portable monitoring device. METHODS: The study participants included consecutive patients with BRVO of less than 3 months duration without any risk factors known to be associated with OSA (diabetes, coronary artery disease, stroke, hematologic diseases, autoimmune disease, etc.) except for hypertension. All patients underwent full-night unattended polysomnography by means of a portable monitor Watch PAT-100 device. The apnea-hypopnea index (AHI) was calculated as the average number of apnea and hypopnea events per hour of sleep, and an AHI score of five or more events was diagnosed as OSA. RESULTS: Among 19 patients (6 males and 13 females), 42.1% (8 of 19) had an AHI reflective of OSA. In the 13 patients who had no concurrent illness, including hypertension, 30.8% (4 of 13) had positive test results for OSA; three of these patients were ranked as mild OSA, while one had moderate OSA. The OSA group had an average AHI of 12.3 ± 7.8, and the average AHI was 2.0 ± 0.9 in the non-OSA group. Although it was not statistically proven, we found that OSA patients experienced a more severe form of BRVO. CONCLUSIONS: We found a higher than expected rate of OSA in BRVO patients lacking concomitant diseases typically associated with OSA. Our findings suggest that OSA could be an additional risk factor in the pathogenesis of BRVO or at least a frequently associated condition that could function as a triggering factor.
Apnea ; Autoimmune Diseases ; Coronary Artery Disease ; Hematologic Diseases ; Humans ; Hypertension ; Male ; Polysomnography ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Risk Factors ; Sleep Apnea, Obstructive* ; Stroke

Purpose: To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. Conclusions Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.

Purpose: To describe a case of acute retinal necrosis with clinical features of orbital inflammation.Case summary: A 33-year-old female presented with right eye injection, chemosis, and pain. At the first visit, the uncorrectedvisual acuity and intraocular pressure of her right eye were 20/20 and 20 mmHg, respectively. Slit-lamp examination showed inflammatorycell 2+ in the anterior chamber of the right eye; an evaluation of the peripheral retina was not conducted. The nextday, computed tomography (CT) was performed due to aggravation of the orbital inflammation. High-dose intravenous methylprednisoloneinjection was initiated on the finding of posterior scleritis with orbital inflammation on CT scans; peripheral retinalnecrosis and obstructive vasculitis were also noted. Clinically determined to be acute retinal necrosis, the patient began systemicantiviral therapy. A diagnostic anterior chamber paracentesis was positive for herpes simplex virus type 2 by polymerasechain reaction. The patient was treated with intravenous acyclovir and intravitreal injections of foscarnet, as well as barrier lasertherapy. After two weeks of treatment, the patient was discharged with oral valacyclovir. During the three months of follow-up,the visual acuity of the right eye was hand motion, due to chronic optic disc swelling with chronic macular edema and maculardegeneration. Neither eye showed retinal lesion progression. Conclusions Rarely, acute retinal necrosis is accompanied by clinical manifestations of orbital inflammation. Therefore, if patientshave uveitis with orbital inflammation, it is important to consider the possibility of acute retinal necrosis and to examine theperipheral retina carefully.

Purpose: To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. Conclusions Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.

Purpose: We present a modified, closed-loop scleral fixation technique. We inserted a 4-eyelet intraocular lens (IOL) into the anterior chamber prior to fixation. We investigated the clinical results. Methods: We retrospectively reviewed 39 eyes (39 patients) that underwent modified four-point scleral fixation of an inserted lens in our center from May 2019 to June 2022. The surgical procedure features conjunctival peritomy, 4-eyelet IOL insertion, eyeball penetration using a 9-0 polypropylene needle, eyelet placement using an ab externo technique to form a continuous loop, centering of the optic, and tying of a knot. We compared preoperative and 6-month postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure, and refraction errors, and described postoperative complications. Results: The mean patient age was 62 years. The indications for surgery included complicated cataracts (20.5%), aphakia (20.5%), staged surgery for complicated cataract (12.8%), non-traumatic IOL dislocation (30.8%), traumatic IOL dislocation (12.8%), and crystalline lens dislocation (5.1%). The postoperative BCVA (0.40 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the preoperative BCVA (0.69 logMAR) (p = 0.018). The postoperative spherical equivalent and the target diopter measurement were in high agreement (p = 0.002, intraclass correlation coefficient = 0.616). All of ocular hypertension (7.7%), hypotony (5.1%), bullous keratopathy (5.1%), and macular edema (5.1%) were noted, but 78% of the conditions improved with short-term medication. There was no re-dislocation of a fixated IOL. Conclusions Our surgical technique simply and rapidly treats aphakia. Optic repositioning was easy, the IOL stability high, and the risk of complications during IOL fixation low.