Neuropathic pain markedly impairs quality of life and imposes a substantial socioeconomic burden, while available treatments often provide only partial relief and are limited by safety concerns. The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG-IASP) first published pharmacologic recommendations in 2007, followed by a major update in 2015 and a new guideline in 2025. This narrative review specifically compares the 2015 and 2025 NeuPSIG-IASP guidelines, outlining key methodological changes and therapeutic shifts. The 2025 guideline is based on a larger, more rigorous meta-analysis, maintains α2δ-ligands (adds mirogabalin), serotonin-noradrenaline reuptake inhibitors, and tricyclic antidepressants as first-line drugs, downgrades tramadol into the opioid third-line group. It also introduces high-frequency motor-cortex repetitive transcranial magnetic stimulation as a weakly recommended third-line option and discusses implications for Korean clinical practice.

Background: Transthyretin amyloidosis, a protein-misfolding disorder characterized by systemic amyloid deposition, can be classified as wild-type transthyretin amyloidosis (ATTRwt) or hereditary transthyretin amyloidosis (ATTRv), depending on the presence of transthyretin (TTR) gene variants. We examined the genetic distribution of TTR variants in Korean patients diagnosed with ATTRv. Methods: We retrospectively reviewed 801 participants who underwent TTR analysis at Samsung Medical Center from 2012 to 2024. The participants were categorized into two groups: in-house probands or relatives, and externally referred probands or relatives. Results: Pathogenic or likely pathogenic TTR variants were detected in 36 of 165 in-house probands (21.8%), among which D38A was the most frequent variant (50.0%; 18/36), followed by M13dup and E89K (8.3% each). Among referred probands, D38A was predominant (54.5%; 12/22), followed by M13dup (22.7%; 5/22). Cardiac amyloid involvement was the most common manifestation, observed in 97.2% (35/36) of in-house probands with ATTRv, followed by peripheral nervous system (PNS; 94.4%) and autonomic nervous system (ANS; 88.9%) involvement. In contrast, ANS involvement was most prevalent among in-house relatives who underwent organ evaluation (61.5%; 24/39), followed by cardiac (52.1%; 25/48) and PNS (48.7%; 19/39) involvement. Five of the eight in-house relatives harboring M13dup (62.5%) showed organ involvement, primarily in the ANS, supporting the pathogenicity of this variant. Conclusions This study provides the largest single-institution dataset of Korean patients with ATTRv, incorporating systematic organ assessments. The predominance of the unique TTR variants D38A and M13dup delineates a distinct genetic landscape that may facilitate accurate and timely diagnosis of ATTRv in the Korean population.

Background: Fusion genes are major drivers of acute leukemia. Conventional diagnostics are limited in detecting the diverse fusions included in recently updated acute leukemia classifications. We evaluated the fusion detection performance of RNA sequencing (RNAseq) compared with that of conventional diagnostics in patients with acute leukemia. Methods: We retrospectively obtained the data of 101 patients with acute leukemia who underwent conventional diagnostics (i.e., karyotyping, FISH, or multiplex reverse transcription PCR) at diagnosis at Samsung Medical Center, Seoul, Korea, between September 2022 and September 2023. Whole RNA-seq was performed using the Illumina Stranded mRNA Prep kit (Illumina, San Diego, CA, USA). The concordance, sensitivity, and specificity of RNA-seq for fusion gene detection were compared with those of conventional diagnostics. Results: RNA-seq helped identify 52 fusion genes in 51 (50.5%) of 101 patients, with detection rates of 40.7%, 70.3%, 37.5%, and 50% in acute myeloid leukemia, B-cell acute lymphoblastic leukemia, T-cell acute lymphoblastic leukemia, and mixed-phenotype acute leukemia, respectively. RNA-seq showed 83.3% sensitivity and 80.8% concordance with conventional diagnostics; it missed eight fusions, likely because of low transcript abundance or enhancer hijacking. RNA-seq also helped clarify three previously unspecified rearrangements and detected 12 fusions (21.4%) in 56 cases that tested negative with conventional diagnostics, including four novel (KMT2A::THAP12 , RUNX1::PRPF19 , MLLT10::UBE2L6, and FUS::ZNF362) and three rare (HNRNPH1::ERG, RUNX1::USP42, and ETV6::NCOA2) fusions. Conclusions This was the first study to evaluate the performance of whole RNA-seq in fusion detection in patients with acute leukemia in Korea. Incorporating RNA-seq into diagnostic workflows may facilitate earlier and more precise therapeutic decisions and improve prognostic assessment in patients with acute leukemia.

South Korea’s current healthcare system stands at a critical crossroads that will determine whether it can progress in a better direction over the next decade. Behind the relatively stable level of population health that has been maintained until now, it has become clear that the deterioration of patient experiences, the risk of collapse in critical emergency medical services, the burnout of healthcare providers, and the crisis in the sustainability of healthcare finances have all accumulated simultaneously. This crisis can no longer be overcome by partial fixes or short-term measures alone. The answer to what needs to change first must begin with a reaffirmation of what the healthcare system should aim for. Ultimately, what needs to be changed now is not an individual policy, but the criteria and priorities through which we view healthcare. The focus must shift from what to provide more of, to questioning what holds greater social value. If such a shift does not begin now, in ten years we won’t face a better healthcare system, but care enmeshed in a deeper crisis. Now is precisely the time to fundamentally define the direction of the healthcare system.

Myopia, particularly high myopia, is a significant risk factor for several ocular pathologies including cataract, glaucoma, and retinal detachment. Excessive axial elongation associated with high myopia can induce biomechanical stretching, increasing the risk of serious complications like posterior staphyloma and myopic maculopathy. Global meta-analyses estimate that approximately 10 million people were visually impaired due to myopic maculopathy in 2015, with 3 million being blind. Recent nationwide surveys in South Korea revealed a prevalence of 65.4% for myopia and 6.9% for high myopia in children and adolescents, highlighting the urgent need for effective management. Delaying the onset and slowing the progression of myopia during childhood and adolescence is crucial for reducing the potential lifetime risk of these complications. This consensus statement, prepared by the Korean Myopia Society for the Korean Association for Pediatric Ophthalmology and Strabismus (KAPOS), reviews the current evidence for myopia control interventions and provides management strategies applicable to the South Korean clinical setting. Key interventions covered include lifestyle modifications (outdoor time, near work adjustment), optical methods (myopia-control spectacle lenses, dual-focus soft contact lenses, orthokeratology), and pharmacologic treatment (low-concentration atropine), as well as combination therapies. The statement also addresses patient selection, treatment outcome evaluation using spherical equivalent and axial length changes, and the crucial aspects related to treatment cessation and the rebound effect.

Purpose: To evaluate functional and anatomical outcomes, including vessel morphology parameters on swept-source optical coherence tomography angiography (SS-OCTA), in eyes with neovascular age-related macular degeneration (nAMD) switched to brolucizumab. Methods: This retrospective study included 37 eyes with nAMD that were switched from other anti–vascular endothelial growth factor (anti-VEGF) agents to intravitreal brolucizumab. Best-corrected visual acuity (BCVA), injection intervals, central subfield thickness (CST), pigment epithelial detachment (PED), and presence of retinal fluid were compared between baseline and 12 months after switch. SS-OCTA images were analyzed to quantify macular neovascularization (MNV) area, vessel density, fractal dimension (FD), and lacunarity. Results: Switching to brolucizumab significantly extended injection intervals and reduced CST, PED height and retinal fluid, while maintaining BCVA at 12 months. Quantitative OCTA analysis showed reductions in MNV area and FD following the switch. When compared with the preceding 12 months of other anti-VEGF therapy, FD still showed a significant reduction after brolucizumab treatment (p = 0.019). Intraocular inflammation occurred in one eye and resolved with topical corticosteroids. Conclusions Intravitreal brolucizumab demonstrated favorable anatomical improvements and maintained visual outcomes over 12 months. Quantitative OCTA biomarkers, particularly FD, may serve as imaging indicators of disease activity and treatment response in eyes with nAMD undergoing a therapy switch.

Purpose: This study aimed to quantitatively evaluate longitudinal changes in drusen area and volume over 36 months in South Korean patients and to identify the factors associated with these changes and the development of advanced age-related macular degeneration (AMD). Methods: In this retrospective study, 38 eyes from 38 patients diagnosed with drusen were analyzed. The drusen area and volume were measured using spectral-domain optical coherence tomography (SD-OCT; Cirrus 5000, Carl Zeiss Meditec) with an automated retinal pigment epithelium elevation map algorithm. To minimize bias from variable follow-up intervals, an annualized classification framework was adopted. Based on percentage change in drusen area within the 5-mm circle, eyes were categorized as progressed (increase >20%), stable (change within ±20%), or regressing (decrease >20%). Results: Both drusen area and volume increased significantly up to 24 months (area, p = 0.003; volume, p = 0.028) and then showed a modest decline at 36 months, remaining above baseline levels. No significant difference in the proportions of progressed, stable, or regressing eyes was observed across 12-month intervals or compared with baseline (all p > 0.05). A larger baseline 5-mm drusen area was significantly associated with the development of advanced AMD (adjusted odds ratio, 2.818; 95% confidence interval, 1.022–7.767; p = 0.045). Eyes that exhibited at least one episode of drusen regression showed a higher incidence of advanced AMD (36.8% vs. 5.3%, p = 0.042). Conclusions Drusen in South Korean patients demonstrated dynamic morphological remodeling over time. Drusen regression was not a benign phenomenon but rather a potential high-risk marker for progression to advanced AMD. These findings highlight the importance of population-specific, quantitative SD-OCT monitoring for early risk stratification in East Asian eyes.

Purpose: This study aims to determine whether the translucency-based clinical grade of pterygium shows independent relationships with anterior and posterior corneal curvature and anterior wavefront aberrations, with adjustment for horizontal invasion length (HIL) measured by anterior segment (AS) swept-source optical coherence tomography (SS-OCT). Methods: This study involved 53 eyes from 51 patients diagnosed with primary nasal pterygium. The clinical grade of the pterygium was evaluated using T grade based on the fibrovascular translucency. AS SS-OCT (Anterion, Heidelberg Engineering) provided HIL (in millimeters), thickness (in micrometers), anterior/posterior keratometry at the 3.0-mm ring, and anterior corneal wavefront metrics within a 6.0-mm zone. The device was also used to evaluate the magnitudes for the individual first-to fourth-order aberrations of the anterior corneal fields. Also, the fourth- to seventh-order root mean square (RMS), RMS lower-order aberration (LoA), and RMS higher-order aberration (HoA) values were collected. For statistical analysis, Spearman rank correlation test and Pearson correlation test were performed, along with partial correlation test adjusted for HIL. Results: The mean age of subjects was 59.3 ± 11.4 years, and 51.0% were female. T grade correlated positively with HIL. HIL showed strong associations with anterior simulated keratometry (Sim K) average, anterior Sim K steep, anterior Sim K flat, and anterior corneal astigmatism—but not with posterior corneal parameters. HIL also showed significant correlations with multiple anterior corneal wavefront parameters. After adjustment for HIL, T grade remained independently correlated with anterior Sim K flat, RMS LoA, and defocus; no significant relationships were observed with other Zernike terms or posterior metrics. Additionally, T grade was positively correlated with pterygium thickness. Conclusions T grade adds independent, complementary information (associations with flat keratometry, LoA RMS, and defocus) even after controlling for HIL. Incorporating T grade into preoperative assessment may improve estimation of optical burden and surgical prognosis.