Background: With increasing life expectancy, the number of older adults with multiple chronic conditions requiring complex medication regimens is growing, raising concerns about polypharmacy and potentially inappropriate medication (PIM) use. This study investigated trends in polypharmacy and PIM use among 66-year-olds in South Korea from 2012 to 2021, considering participant characteristics, to inform interventions and policies. Methods: A repeated cross-sectional study was conducted using the National Health Insurance Services database covering approximately 97% of Koreans. We included 3,397,044 individuals aged 66 who underwent the National Screening Program for Transitional Ages between 2012 and 2021. Polypharmacy was defined as the use of ≥5 medications for ≥90 days annually, hyper-polypharmacy as ≥10 medications, and PIM use as ≥1 PIM for ≥28 days. Trends were analyzed by sex, frailty, comorbidity, income, insurance type, and residence. Results: Polypharmacy prevalence increased from 32.0% in 2012 to 35.4% in 2021, and hyper-polypharmacy also rose. PIM use slightly decreased from 55.7% to 53.7%. Higher rates of polypharmacy and PIM use were observed among rural residents, medical aid beneficiaries, and those with lower income. Despite improvements in comorbidity and frailty, socioeconomic disparities widened, particularly among medical aid beneficiaries. Frequently prescribed PIMs included NSAIDs, PPIs, muscle relaxants, and anxiolytics/hypnotics. Conclusion While PIM use slightly decreased over the study period, it remained above 50%, and polypharmacy prevalence increased among older adults in Korea. Socioeconomic disparities in medication use persist, highlighting the need for targeted interventions and policies to promote safe medication use among vulnerable groups.

Purpose: To investigate the clinical features of non-affected fellow eyes in patients with unilateral facial port-wine stain (PWS) and ipsilateral secondary glaucoma. Methods: We performed a retrospective analysis of the medical records of 35 patients with unilateral facial PWS glaucoma and those of controls (35 subjects without both facial PWS and glaucoma) between September 1996 and May 2020. We noted patients’ age at the glaucoma diagnosis (for unilateral facial PWS glaucoma patients) or at the initial examination (for controls), cup-to-disc ratio (CDR), and intraocular pressure (IOP). We compared the clinical features between the glaucoma-free eyes in patients with unilateral facial PWS glaucoma and the controls. Results: The mean age at the glaucoma diagnosis for unilateral facial PWS glaucoma patients was 0.56 ± 0.99 years (range, 0.08-4). The mean IOP of the glaucoma-free eyes was 16.68 ± 5.73 mmHg (range, 9-22.9), and the mean CDR was 0.37 ± 0.14 (range, 0.15-0.80) at glaucoma diagnosis. The mean IOP of the glaucoma-free eyes was 14.14 ± 6.29 mmHg (range, 8.1-26.7), and the mean CDR was 0.37 ± 0.12 (range, 0.26-0.82) at final examination. When comparing glaucoma-free eyes of the unilateral facial PWS glaucoma patients with the control group (mean age, 11.2 ± 7.4 years), the mean CDR was significantly greater (0.37 ± 0.12 vs. 0.30 ± 0.08; p = 0.014) but there was no significant difference in the mean IOP (14.14 ± 6.29 mmHg vs. 14.57 ± 2.49 mmHg; p = 0.712). Conclusions The glaucoma-free eyes of unilateral facial PWS glaucoma patients showed greater CDR compared to the non-facial PWS and non-glaucoma controls. Additional longitudinal studies are needed to investigate the clinical course of those eyes, whether the risk of developing glaucoma is increased.

Purpose: To compare the ocular biometry and postoperative refractive outcomes using two devices; the swept-source opticalcoherence tomography biometer (Argos) versus the partial coherence interferometer (IOL Master®500, Carl Zeiss Meditec AG,Jena, Germany). Methods: The axial length (AL), anterior chamber depth (ACD) and keratometry (K) in 221 cataract eyes were measured withArgos and IOL Master®500. One month after surgery, refraction of the respective eyes was conducted and the mean absoluteerror (MAE) calculated for analysis of the refractive outcomes. Results: Measurement was not possible in 13 eyes with the IOL Master®500 but was possible with Argos. Measurement was notpossible in one eye with either biometer. Agreement in measured ocular biometry between the two devices by intraclass correlationcoefficient (ICC) and Bland-Altman plot (ICC AXL = 0.999, ACD = 0.975, K = 0.978) was excellent. The AL and ACD measuredwith Argos were significantly longer than measured with IOL Master®500 (p= 0.005, p= 0.000). The MAE showed no significantdifference between the Argos and IOL Master®500 (p= 0.087). Conclusions The measurement of ocular biometry was better in Argos than in IOL Master®500. The accuracy of the intraocularlens power calculations of Argos was clinically acceptable and compatible with a conventional device.

PURPOSE: To evaluate the effect of epiretinal membrane (ERM) on the outcomes of intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Thirty eyes of 30 patients who received Ozurdex treatment for ME secondary to BRVO, and were followed-up for at least 6 months were retrospectively reviewed. Patients were divided into two groups based on the presence (ERM [+] or absence ERM [−]) of ERM at baseline. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), recurrence of ME, and retreatment rate were evaluated at baseline, 1, 3, and 6 months after Ozurdex injection. RESULTS: Ten eyes of 30 eyes (33%) showed ERM at baseline. While the mean CFT was significantly reduced at 1 month after Ozurdex injection, it began to increase gradually thereafter in both groups. The ERM (+) group showed a significantly higher mean CFT than the corresponding values of the ERM (−) group at 1 (p = 0.022) and 6 months (p = 0.001) after Ozurdex injection. However, no significant difference was found in the BCVA between the two groups at every visit. The proportion of eyes with ME was significantly higher in the ERM (+) group (90%) than that in the ERM (−) group (35%) at 6 months after Ozurdex injection (p = 0.009). There were no significant differences between the two groups in the percentage of retreatment, time to retreatment, and type of materials used for retreatment. CONCLUSIONS: In patients with ME secondary to BRVO, the treatment effect of Ozurdex was low and the duration of treatment was short when ERM was concurrently present. However, the presence of ERM did not significantly affect visual outcomes after treatment with Ozurdex.
Dexamethasone ; Edema ; Epiretinal Membrane ; Humans ; Macular Edema ; Recurrence ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Retreatment ; Retrospective Studies ; Visual Acuity

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.
Abducens Nerve Diseases ; Accidents, Traffic ; Brain ; Child, Preschool ; Female ; Fractures, Multiple ; Hand ; Humans ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Pneumocephalus ; Pupil ; Retina ; Retinal Artery Occlusion ; Retinal Artery ; Retinal Hemorrhage ; Retinal Vein ; Retinal Vessels ; Retinaldehyde ; Skull ; Veins ; Visual Acuity

PURPOSE: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.
Drainage ; Electronic Health Records ; Humans ; Jupiter ; Lighting* ; Ophthalmoscopes* ; Retinal Detachment ; Retrospective Studies ; Scleral Buckling* ; Slit Lamp ; Subretinal Fluid ; Visual Acuity

PURPOSE: The purpose of this study was to assess the value of adding digital breast tomosynthesis (DBT) to full-field digital mammography (FFDM) in the diagnostic workup of breast cancer and to determine which lesion variables affect cancer detectability in the combined modality. METHODS: Between March and May 2012, paired FFDM and DBT images were obtained from 203 women as part of a diagnostic workup for breast cancer. Images from FFDM alone, DBT alone, and DBT combined with FFDM were reviewed in separate sessions by six blinded readers. Jackknife alternative free-response receiver operating characteristic (JAFROC) figure of merit (FOM), sensitivity, and specificity were compared between the modalities. Lesion characteristics affecting the cancer detection rate when using the combined modality were also analyzed. RESULTS: Among the 203 women, 126 women had a total of 129 malignancies and 77 women had total of 77 benign lesions. The overall JAFROC FOM of the combined modality was higher than that of FFDM alone (0.827 vs. 0.775, p<0.001) and that of DBT alone was higher than that of FFDM alone (0.807 vs. 0.775, p=0.027). The overall sensitivity of the combined modality was higher than that of FFDM alone (80.0% vs. 73.2%, p<0.001) and that of DBT alone was higher than that of FFDM alone (78.3% vs. 73.2%, p=0.007). Compared to FFDM alone, the combined modality detected an additional 48 cancers. Using the combined modality, the presence of masses or microcalcifications was significantly associated with the cancer detection rate (p<0.001). CONCLUSION: The combination of DBT with FFDM results in a higher diagnostic yield than FFDM alone. Additionally, DBT alone performs better than FFDM alone. However, even when DBT is combined with FFDM, breast cancers with no discernible masses and those lacking calcifications are difficult to detect.
Breast Neoplasms ; Breast* ; Early Detection of Cancer ; Female ; Humans ; Imaging, Three-Dimensional ; Mammography* ; ROC Curve ; Sensitivity and Specificity

OBJECTIVE: To retrospectively evaluate the features of undiagnosed breast cancers on prior screening breast magnetic resonance (MR) images in patients who were subsequently diagnosed with breast cancer, as well as the potential utility of MR-computer-aided evaluation (CAE). MATERIALS AND METHODS: Between March 2004 and May 2013, of the 72 consecutive pairs of prior negative MR images and subsequent MR images with diagnosed cancers (median interval, 32.8 months; range, 5.4-104.6 months), 36 (50%) had visible findings (mean size, 1.0 cm; range, 0.3-5.2 cm). The visible findings were divided into either actionable or underthreshold groups by the blinded review by 5 radiologists. MR imaging features, reasons for missed cancer, and MR-CAE features according to actionability were evaluated. RESULTS: Of the 36 visible findings on prior MR images, 33.3% (12 of 36) of the lesions were determined to be actionable and 66.7% (24 of 36) were underthreshold; 85.7% (6 of 7) of masses and 31.6% (6 of 19) of non-mass enhancements were classified as actionable lesions. Mimicking physiologic enhancements (27.8%, 10 of 36) and small lesion size (27.8%, 10 of 36) were the most common reasons for missed cancer. Actionable findings tended to show more washout or plateau kinetic patterns on MR-CAE than underthreshold findings, as the 100% of actionable findings and 46.7% of underthreshold findings showed washout or plateau (p = 0.008). CONCLUSION: MR-CAE has the potential for reducing the number of undiagnosed breast cancers on screening breast MR images, the majority of which are caused by mimicking physiologic enhancements or small lesion size.
Adult ; Aged ; Breast/*pathology ; Breast Neoplasms/*diagnosis/pathology/radiography ; Diagnosis, Computer-Assisted/*methods ; False Negative Reactions ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Mammography/*methods ; Middle Aged ; Retrospective Studies