High Closure Rate Research Articles

Endoscopic hand suturing using a modified through-the-scope needle holder for mucosal closure after colorectal endoscopic submucosal dissection: Prospective multicenter study (with video).

Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through-the-scope needle holder. This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20-50 mm in size located in the sigmoid colon or rectum. A modified flexible through-the-scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end-points were sustained closure rate on second-look endoscopy (SLE) performed on postoperative days 3-4 and suturing time for colorectal EHS. Secondary end-points included complete closure rate and delayed adverse events. We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21-65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3-98.8%]), and the median suturing time was 49 min (range, 23-92 min [95% CI 35-68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1-96.8%]). No delayed adverse events were observed. EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events.

Clinical utility of a novel anchor pronged clip for mucosal defect closure after colorectal endoscopic submucosal dissection (with video)

Abstract Background and study aims The MANTIS Clip (Boston Scientific) is a novel anchor pronged clip designed to enhance tissue grasping and facilitate the closure of defects in the gastrointestinal tract. This study evaluates the feasibility and effectiveness of the MANTIS Clip for closing mucosal defects following colorectal endoscopic submucosal dissection (C-ESD). Patients and methods A retrospective single-center study was conducted on patients who underwent C-ESD with MANTIS Clip closure from May 2023 to April 2024. The primary outcome measured was the complete closure success rate. Secondary outcomes included defect size, sustained closure rate, closure time, number of clips used, adverse events (AEs), and hospital stay duration. Results The MANTIS Clip was used in 52 cases. The complete closure rate was 98.1% (51/52), with a sustained closure rate of 96.1% (49/51). The median closed defect size was 32 mm, with the largest being 62 mm. The median closure time was 8 minutes. Typically, one MANTIS Clip per defect was used, with only one lesion requiring two clips. The median number of additional clips used was seven. AEs included one case of bleeding (1.9%) and one case of post-ESD coagulation syndrome (1.9%), both managed without extending hospital stays. The median C-reactive protein level on the first day post-ESD was 0.35 mg/dL and the median hospital stay was 5 days. Conclusions The MANTIS Clip is effective and practical for mucosal defect closure post-C-ESD, demonstrating high success and sustained closure rates with minimal complications. Future multicenter randomized trials are needed to further assess its efficacy and safety.

Novel reopenable clip with anchor prongs facilitates mucosal defect closure after colorectal endoscopic submucosal dissection: Pilot feasibility study (with video).

Closure of mucosal defects following colorectal endoscopic submucosal dissection (C-ESD) is often performed to prevent post-C-ESD adverse events. However, large mucosal defect closure using conventional clips remains technically challenging. Here, we evaluated the feasibility of the novel endoclip with anchor prongs, called the MANTIS Clip (Boston Scientific, Tokyo, Japan), for mucosal defect closure after C-ESD. This high-volume retrospective study was conducted at a single center. From March until December 2023, consecutive patients who underwent post-C-ESD mucosal defect closure using MANTIS Clip to achieve complete closure were enrolled. Patient clinical characteristics and outcomes were evaluated. Closure of the mucosal defect using the MANTIS Clip was attempted following C-ESD in 32 lesions. The median sizes of the resection specimens and the tumors were 32 mm (range, 17-100 mm) and 23.5 mm (range, 5-96 mm), respectively. The lesions were distributed between the cecum, ascending, transverse, descending, sigmoid, and rectum. Complete closure was achieved in 96.9% of cases (31/32). All lesions up to 61 mm in defect size were completely closed. The median closure time was 7.9 (range, 3.3-18.0) min. The median numbers of MANTIS Clip and additional conventional clips were 3 (range, 1-4) and 5 (range, 1-11), respectively. No adverse events associated with closure, post-ESD bleeding, and delayed perforation occurred. MANTIS Clip closure for large post-C-ESD mucosal defects was found to be feasible and reliable with a high complete closure rate and a short procedure time.

Meta-regression of idiopathic full-thickness macular holes diameter and anatomical closure rate: Implications to intraoperative technique

PurposePrimary surgery failure of macular holes causes poor visual acuity outcomes. Several studies indicate that small-medium idiopathic full-thickness macular holes (iFTMH) have consistent and high anatomical closure rates after vitrectomy and internal limiting membrane (ILM) peeling, regardless of iFTMH diameters. However, there is no systematic analysis examining the relationship between iFTMH diameters and anatomical closure rates. MethodsIn this systematic review and meta-regression, we searched PubMed, Embase, and Web of Science databases on October 24th, 2022. We included studies regarding iFTMH, with ILM peeling/inverted flap technique, long-lasting gas tamponade, and face-down position after surgery. Univariable meta-regression with a restricted cubic spline model and component-plus-residual plot after covariables adjustment were used to explore non-linear association. ResultsA total of 7257 participants from 19 randomized controlled trials and 49 observational studies were included in this meta-analysis. In ILM peeling group, every 100-μm increment in diameter was associated with a 3.8 % (95 % confidence interval [CI], 1.8%–5.7 %, P < 0.001) relatively lower anatomical closure rate. Yet, among studies using the inverted flap technique, baseline iFTMH diameter was not associated with a lower anatomical closure rate (0.2 %, 95%CI, −4.2 %–4.5 %, P > 0.9). The restricted cubic spline model and component-plus-residual plot controlling for age, sex, and symptom duration prior to surgery showed no evident non-linearity in both surgical techniques. ConclusionsThe iFTMH diameter is linear and inversely associated with the anatomical closure rate after the ILM peeling technique, but not with the inverted flap technique. The present study supports the use of advanced techniques, e.g., inverted flap technique, in small-medium iFTMH to improve anatomical closure rates.

Preliminary investigation of endoscopic surgery for tympanic membrane perforation: Regenerative treatment compared with conventional surgery

PurposeTo compare surgical outcomes of regenerative treatment (RT) including basic fibroblast growth factor (bFGF) (Group-R) with the conventional method (Group-C) for patients with tympanic membrane perforation (TMP), both of whom underwent transcanal endoscopic ear surgery. MethodsThe study population of Group-R included 61 ears of 59 patients treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the TMP. Fibrin glue was then dripped over the sponge. Group-C consisted of 13 patients who underwent conventional surgery before adopting the RT-TMP. Patients' characteristics and outcomes including TMP closure rates, and change in hearing level were evaluated three or more weeks after the surgery. ResultsThe baseline characteristics including size of TMP were not significantly different between the two groups. Although Group-R had significantly shorter operating time than Group-C, the complete TMP closure rates were 69 % (9/13) and 85 % (52/61), respectively. Air-conduction hearing thresholds showed significant improvements, and analysis of variance showed that Group-R achieved significant interactions other than at 8 kHz, implying better improvement in cases with TMP closure. The air-bone gaps also improved at all frequencies in both groups. Specifically, at 4 kHz, there was a trend showing better improvement in Group-R. ConclusionRT-TMP had a high TMP closure rate and good hearing improvement, with no significant differences compared with those of conventional surgery. This new therapy is simple and safe, and requires less operating time, and it could help improve the quality of life of patients with TMP.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study.

Flow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data. Data for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded. Forty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits. FDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.

VISUAL OUTCOMES AFTER INTERNAL LIMITING MEMBRANE PEELING VERSUS FLAP IN THE CLOSURE OF FULL-THICKNESS MACULAR HOLES.

To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full-thickness macular holes. Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close full-thickness macular hole at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow-up. Main outcome measures were type 1 primary full-thickness macular hole closure and postoperative best-corrected visual acuity in mean logMAR. One hundred thirty and 30 eyes underwent ILMP and ILMF, respectively. There were no significant differences in baseline characteristics between the groups. Ninety-six percent of ILMP eyes and 90% of ILMF eyes achieved primary hole closure ( P = 0.29). Among all eyes with primary hole closure, best-corrected visual acuity at 1 year was not different between the groups, but when stratified by lens status, it was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean best-corrected visual acuity (Snellen equivalent) (95% confidence interval) was 0.42 (20/50) (0.34, 0.49) in the ILMP group and 0.71 (20/100) (0.50, 0.92) in the ILMF group. Internal limiting membrane peeling and ILMF techniques yielded similarly high full-thickness macular hole closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse best-corrected visual acuity at 1 year.

Foveal-Sparing ILM Peeling with ILM Flap Transposition over the Macular Hole for Repair of Full-Thickness Macular Holes.

Full-thickness macular holes, defined as full-thickness defects of the fovea, lead to central scotoma and deterioration of vision. Apart from peeling of the internal limiting membrane (ILM), ILM flap techniques have been reported to have potential in improving results in macular hole surgery. In addition, foveal-sparing ILM peeling gives a high macular hole closure rate and improvement in postoperative visual acuity. The aim of this study was to examine outcomes in a cohort of patients with full-thickness macular holes that underwent vitrectomy with foveal-sparing ILM peeling and transposition of an ILM flap over the macular hole. This retrospective study included patients scheduled for pars plana vitrectomy with foveal-sparing ILM peeling, combined with ILM flap transposition over the macular hole, for macular hole repair. All patients received a gas tamponade with 20% sulphur hexafluoride and were encouraged to undergo postoperative face-down positioning for 48 hours after surgery. Optical coherence tomography (OCT) imaging of the macula and distance-corrected visual acuity (DCVA) were performed before and 3 months after surgery. In total, 42 eyes of 42 patients were included in this study. Leaving a broad area of residual ILM at the foveal rim led to a high risk of failure in macular hole closure, while leaving a narrow zone of residual ILM at the foveal rim resulted in high macular hole closure rates (97% type 1 closure and 3% type 2 closure), with a median improvement of DCVA of 4lines [interquartile range (IQR): 3 to 6] among pseudophakic and 3.5 lines (IQR: 2 to 5) among phakic patients. A combination of foveal-sparing ILM peeling with ILM flap techniques was shown to be a safe and effective surgical option for patients with full-thickness macular holes, resulting in a high macular hole closure rate and improvement in visual acuity in the majority of patients.

CHARACTERISTICS, OUTCOMES, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES OF MACULAR HOLE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate full-thickness macular holes (FTMHs) that develop after rhegmatogenous retinal detachment (RRD) repair. Retrospective consecutive case series of patients who underwent RRD repair between 2015 and 2021 and subsequently developed FTMH. Twenty-three patients (23 eyes) were included. All eyes underwent pars plana vitrectomy + membrane peel for macular hole (MH) repair. The mean age at RRD diagnosis was 62 years and 52% were male. In total, 78% were macula-off RRDs. Fourteen eyes (60.9%) underwent pars plana vitrectomy alone, 7 (30.4%) underwent pars plana vitrectomy and scleral buckling, 1 (4.3%) underwent scleral buckling only, and 1 (4.3%) underwent pneumatic retinopexy. Median time from RRD repair to MH diagnosis was 116 days. Macula-off RRDs had a significantly lower time to MH diagnosis (mean 154 days, P < 0.05) than macula-on RRDs (mean 875 days). Twenty-one MH (91%) had optical coherence tomography evidence of an epiretinal membrane. Mean logMAR visual acuity at MH diagnosis was 1.05 (∼20/224) and significantly improved to 0.66 (∼20/91) at the final follow-up ( P < 0.001); 100% of MHs closed by the final follow-up. Pars plana vitrectomy for MH after RRD repair has a high closure rate and leads to significant VA improvement. MH formation after RRD repair may be associated with macula-off detachments and epiretinal membrane. Macula-off RRDs develop MH faster than macula-on RRDs.

Outcomes and success of amniotic membrane transplantation for the treatment of corneal diseases#

Purpose The amniotic membrane (AM), the inner layer of the placenta, is a semitransparent, avascular, and thin tissue that is useful due to its structure. Amniotic membrane transplantation (AMT) avoids the need for keratoplasty to prevent corneal perforating. The purpose of the study was to evaluate the visual (gain of or no change in visual acuity) and corneal outcomes (closure of the ulcer or corneal healing) of AMT in patients with ocular surface diseases. Materials and methods This was a retrospective case control study (success or failure of the surgery). It was undertaken at a single academic center. The study cohort consisted of subjects with ocular surface diseases. Patients were treated with AMT for refractory ocular surface diseases. They were divided into five subgroups according to the preoperative diagnosis. The technique of AMT used was the onlay method with two layers of AM. Primary outcome measures included best corrected visual acuity (BCVA), the number of AMTs, and reepithelization of the corneal epithelium at the end of the treatment. Two weeks to six months were given to consider epithelial closure. Treatment success was defined as corneal healing within 6 months. Results A total of the 66 eyes of 66 patients (39 male/27 female) with a mean age of 44 ± 23 years (range 1–88 years) were included in the study. A single AMT procedure achieved epithelial closure in 74.2% (n = 49) of the eyes (53% in <15 days, 19.6% in 15–30 days, and 1.5% in 1–6 months). The fastest reepithelization occurred in neurotrophic keratopathy, 76.9% of which cases occurred within 15 days after the AMT procedure. Treatment failure was observed in five patients (7.5%), four with keratitis and one with neurotrophic keratopathy. The highest closure rates were found in persistent epithelial defects, graft-versus-host disease (GvHD), and bullous keratopathy, although there was no statistically significant difference in BCVA. Pairwise comparisons were made of neurotropic keratoplasty versus bullous keratopathy (P = 0.025), neurotrophic keratopathy versus keratitis (P = 0.004), GVHD versus keratitis (P = 0.003), and lastly, GvHD versus bullous keratopathy (P = 0.023). Conclusions AMT is a safe, valuable, and fast treatment technique to treat corneal epithelial defects stemming from different etiologies that are refractory to conventional treatment.

Clinical Performance of the Gore Septal Occluder in Patent Foramen Ovale Closure in Different Septal Anatomies: 1-Year Results from a Single-Center Experience.

PFO (Patent foramen ovale) is a common defect that affects about 25% of the population. Although its presence is asymptomatic in the majority of the cases, the remaining part becomes overt with different symptoms, including cryptogenic stroke. PFO closure is currently a widely available procedure in complex anatomy, with Amplatzer PFO Occluder (APO) being the most commonly used tool. However, the performance of another device, the GORE Septal Occluder (GSO), has not been completely explored with regard to different septal anatomies. From March 2012 to June 2020, 118 consecutive patients with an indication of PFO closure were treated using the GSO system, included in a prospective analysis, and followed. After 12 months, every patient underwent transcranial Doppler ultrasound to evaluate the effectiveness of treatment. Of 111 patients evaluated, 107 showed effective PFO closure (96.4%), and 4 showed a residual shunt (3.6%). To better evaluate the device performance, the overall population was sorted into two clusters based on the echocardiographic characteristics. The main difference between groups was for PFO width (4.85 ± 1.8 vs. 2.9 ± 1 mm, p < 0.001) and PFO tunnel length (12.6 ± 3.8 vs. 7.2 ± 2, p < 0.001), allowing complex and simple anatomies to be identified, respectively. Regardless of the aforementioned cluster, the GSO performance required to reach an effective closure was independent of anatomy type and the chosen device size. The GSO device showed a high closure rate at 1-year follow-up in patients, with at least one anatomical factor of complexity of PFO irrespective of the level of complexity itself.

Multicenter phase II trial of transanal total mesorectal excision for rectal cancer: preliminary results

BackgroundTransanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report long-term oncologic and functional results. We report early results from a North American prospective multicenter phase II trial of taTME (NCT03144765).Methods100 patients with stage I–III rectal adenocarcinoma located ≤ 10 cm from the anal verge (AV) were enrolled across 11 centers. Primary and secondary endpoints were TME quality, pathologic outcomes, 30-day and 90-day outcomes, and stoma closure rate. Univariable regression analysis was performed to assess risk factors for incomplete TME and anastomotic complications.ResultsBetween September 2017 and April 2022, 70 males and 30 females with median age of 58 (IQR 49–62) years and BMI 27.8 (IQR 23.9–31.8) kg/m2 underwent 2-team taTME for tumors located a median 5.8 (IQR 4.5–7.0) cm from the AV. Neoadjuvant radiotherapy was completed in 69%. Intersphincteric resection was performed in 36% and all patients were diverted. Intraoperative complications occurred in 8% including 3 organ injuries, 2 abdominal and 1 transanal conversion. The 30-day and 90-day morbidity rates were 49% (Clavien–Dindo (CD) ≥ 3 in 28.6%) and 56% (CD ≥ 3 in 30.4% including 1 mortality), respectively. Anastomotic complications were reported in 18% including 10% diagnosed within 30 days. Higher anastomotic risk was noted among males (p = 0.05). At a median follow-up of 5 (IQR 3.1–7.4) months, 98% of stomas were closed. TME grade was complete or near complete in 90%, with positive margins in 2 cases (3%). Risk factors for incomplete TME were ASA ≥ 3 (p = 0.01), increased time between NRT and surgery (p = 0.03), and higher operative blood loss (p = 0.003).ConclusionWhen performed at expert centers, 2-team taTME in patients with low rectal tumors is safe with low conversion rates and high stoma closure rate. Mid-term results will further evaluate oncologic and functional outcomes.Graphical abstract

Relaxing Retinotomy in Recurrent and Refractory Full-Thickness Macular Holes: The State of the Art.

The prevailing standard of care for primary repair of full-thickness macular holes (FTMHs) is pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, as it gives a high closure rate of roughly 90%. On the other hand, the surgical management of recurrent and refractory FTMHs represents, so far, a demanding and debated subject in vitreoretinal surgery since various approaches have been proposed, with no consensus concerning both adequate selection criteria and the best surgical approach. In addition, the existence of multiple case series/interventional studies showing comparable results and the lack of studies with a direct comparison of multiple surgical techniques may lead to uncertainty. We present an organized overview of relaxing retinotomy technique, a surgical approach available nowadays for the secondary repair of recurrent and refractory FTMHs. Besides the history and the description of the various techniques to perform relaxing retinotomies, we underline the results and the evidence available to promote the use of this surgical approach.

Closure rates and patterns after light silicone oil tamponade for persistent full-thickness macular holes

PurposeTo report outcomes of re-vitrectomy using light silicone oil (SO) tamponade for persistent macular holes (MHs).MethodsWe reviewed cases of patients with full-thickness MHs that underwent pars plana vitrectomy (PPV) with air/gas and were re-vitrectomized using light SO tamponade after primary non-closure (persistent MHs). Outcome measures included anatomic closure rates and patterns confirmed by optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA).ResultsA total of 42 eyes of 41 patients with unsuccessful primary PPV with air/gas were included. After re-vitrectomy with light SO (1000-centistoke), 29 (69%) eyes demonstrated type 1 closure without neurosensory defects in OCT scans, whereas 9 eyes (21%) showed type 2 closure with persisting neurosensory defects. Available data (n = 21) showed a significant mean improvement of BCVA from 0.99 logMAR (SD 0.25, range 0.7–1.3) preoperatively to 0.74 logMAR (SD 0.42, range 0.2–1.5) postoperatively (p = 0.035).ConclusionThe treatment of persistent MHs with PPV and light SO tamponade resulted in high closure rates.

Rates of nursing home closures were relatively stable over the past decade, but warrant continuous monitoring.

For years, nursing home closures have been a concern for the industry, policymakers, consumer advocates, and other stakeholders. We analyzed data from 2011 through 2021 and did not find persistent increases in the closure rates. Closures were relatively stable from 2011 to 2017, averaging 118 facilities (0.79%) per year and increasing to 143 (0.96%) in 2018 and 200 (1.34%) in 2019. Closures decreased during the COVID-19 pandemic, averaging 133 facilities in 2020 and 2021 (0.90%). Medicaid-only nursing facilities had higher closure rates than Medicare-only skilled-nursing facilities and dually certified nursing homes. The Census regions (divisions) of the South (West South Central) and Northeast (New England) had the highest closure rates, while the South (South Atlantic and East South Central) had the lowest rates. Facility characteristics associated with increased closure risk included smaller size, lower occupancy rate, urban location, no ownership changes, lower inspection survey ratings, higher staffing ratings, higher percentages of non-White residents and Medicaid residents, lower percentages of Medicare residents and residents with severe acuity, and location in states with more nursing home alternatives. Additional research should examine the impact of closures on resident outcomes and access to care.

Low delayed bleeding and high complete closure rate of mucosal defects with the novel through-the-scope dual-action tissue clip after endoscopic resection of large nonpedunculated colorectal lesions (with video)

Background and AimsComplete closure following endoscopic resection (ER) of large non-pedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual action tissue (DAT) has clip arms that open and close independent of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after ER of LNPCLs. MethodsMulticenter prospective cohort study of all patients who underwent defect closure with the DAT clip following endoscopic mucosal resection (EMR) or submucosal dissection (ESD) of LNPCLs ≥ 20 mm from July 2022 to May 2023. Delayed bleeding was defined as bleeding event requiring hospitalization, blood transfusion or any intervention within 30 days after the procedure. Complete closure was defined as apposition of mucosal defect margins without visible submucosal areas < 3 mm along the closure line. ResultsA total of 107 patients (median age 64 years; 42.5% women) underwent EMR (n=63) or ESD (n=44) of LNPCLs (median size 40 mm; 74.8% right colon) followed by defect closure. Complete closure was achieved in 96.3% (n=103) with a mean of 1.4±0.6 DAT and 2.9±1.8 TTS clips. Delayed bleeding occurred in one patient (0.9%) without requiring additional interventions. ConclusionThe use of the DAT clip in conjunction with TTS clips achieved high complete defect closure after ER of large LNPCLs and was associated with a 0.9% delayed bleeding rate. Future comparative trials and formal cost-analyses are needed to validate these findings.

Microstructural and microperimetric comparison of internal limiting membrane peeling and insertion in large idiopathic macular hole

BackgroundThe internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion.MethodsThis retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively.ResultsFor idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group.ConclusionFor initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.

Short-Term Clinical Results After ILM Removal and Inverted ILM Flap for Macular Hole Repair - A Single-Center Retrospective Experience.

To compare results after ILM peeling and ILM inverted flap technique utilized the repair of full thickness macular holes, irrespective of their size. Pre- and postoperative data of 109 patients who suffered from a full thickness macular hole were retrospectively analyzed. Forty-eight patients were treated with an inverted ILM flap technique, 61 patients were treated with ILM peeling. All patients received a gas tamponade. The primary endpoint was macular hole closure as demonstrated by OCT scanning. Secondary endpoints were best corrected visual acuity and clinical complication rates. For small and medium-sized macular holes the closure rates in the ILM flap technique group were 100% and 94%, respectively. For ILM peeling, the closure rate was identical (95%). For large macular holes, the closure rate was 100% in the flap versus 50% in the ILM peeling group, but visual acuity improved in both groups (ILM flap p=0.001, ILM peeling p=0.002). In both treatment groups, larger holes were associated with a reduced final visual outcome. For medium-sized macular holes, visual acuity significantly improved only in the ILM peeling group. Both techniques were associated with minimal and comparable side effects. In our limited series, the inverted ILM flap technique for repair of macular holes demonstrated a high closure rate. For large MHs, we saw a trend towards a better closure rate in the flap technique compared to ILM peel only. However, final visual acuity showed no significant difference between the groups. Clinical results and complications appeared to be comparable in both groups.

What Factors Delay Interatrial Communications Closure in the Oval Fossa?

Purpose: In most neonatal intensive care units, echocardiography is performed at the bedside. The lack of closure of interatrial communications (IACs) in the oval fossa can affect mortality and morbidity. This study aimed to establish the rate of spontaneous closure of IACs diagnosed in the neonatal period and predict the need for subsequent evaluation according to various factors, including defect size and shape.Methods: The study group comprised 1,242 newborns admitted between March 2017 and December 2020. We judged the closure of the IACs and evaluated the risk factors of each. Patients were classified into the absence or presence of IACs. The morphology of the IACs was classified into atrial septal defects, patent foramen ovale, and multiple holes.Results: A total of 317 patients (131 female, 186 male) were enrolled in the study, and the average defect size was 3.0±1.0 mm. An overall spontaneous closure rate of 89.9% was observed during an average follow-up interval of 5.1±1.1 months. When multiple Cox regression analyses were performed to analyze the risk factors for spontaneous closure, initial defect size was a significant factor. The optimal cut-off value for predicting spontaneous closure of the IAC was 3.05 mm, and the area under the receiver operating characteristic curve was 0.625 (95% confidence interval, 0.520 to 0.729). Preterm infants had a larger defect size corrected for birth weight and a higher closure rate than term infants.Conclusion: Other than large defect size, no factors delayed spontaneous closure. When defects in the oval fossa measure ≤3 mm, most patients experience spontaneous closure by 7 months of age.