Vitrectomy vs. Spontaneous Closure for Traumatic Macular Hole: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis aimed to determine the traumatic macular hole (TMH) closure rate and visual acuity (VA) improvement rate by comparing two treatment methods for TMH: vitrectomy and observation for spontaneous closure.Methods: PubMed, Cochrane, Web of Science Library, Embase, CNKI, Wanfang, VIP, and Sino Med were systematically searched from their inception to June 10, 2021. Studies in the surgery group (n = 32) and studies in the observation group (n = 12) were meta-analyzed. The primary outcomes were the TMH closure and VA improvement rates in the surgery and observation groups. The secondary outcomes were best-corrected visual acuity (BCVA) improvement in the surgery group. Stata software (version 15.1) was used for the analyses.Results: Thirty-six studies that included 1,009 eyes were selected for this meta-analysis, among which 33 were retrospective studies and 3 were prospective studies. The meta-analysis showed that the random-model pooled event rate for TMH closure was 0.37 (95% confidence interval [CI], 0.26–0.48) in the observation group, while it was 0.9 (95% CI, 0.85–0.94) in the surgery group. The fixed-model pooled event rate for VA improvement was 0.39 (95% CI, 0.33–0.45) in the observation group, while the random-model pooled event rate of VA improvement for the surgery group was 0.72 (95% CI, 0.63–0.80). The pooled event rate for BCVA improvement in the surgery group was 0.39 (95% CI, 0.33–0.46).Conclusions: This meta-analysis suggests that TMH hole closure and VA improvement rates in the surgery group were significantly higher than those in the observation group. Vitrectomy is an effective method for treating TMH. However, further randomized controlled trials (RCTs) are required to evaluate the efficacy and safety of surgery and observation for TMH treatment.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021276684.

Spontaneous Closure of the Arterial Duct after Transcatheter Closure Attempt in Preterm Infants

(1) Background: Transcatheter closure of the patent arterial duct (TCPDA) in preterm infants is an emerging procedure. Patent arterial duct (PDA) spontaneous closure after failed TCPDA attempts is seen but reasons and outcomes are not reported; (2) Methods: We retrospectively included all premature infants <2 kg with abandoned TCPDA procedures from our institutional database between September 2017 and August 2021. Patients’ data and outcomes were reviewed; (3) Results: The procedure was aborted in 14/130 patients referred for TCPDA. Two patients had spasmed PDA upon arrival in the catheterization laboratory and had no intervention. One patient had ductal spasm after guidewire cross. Four patients had unsuitable PDA size/shape for closure. In seven patients, device closure was not possible without causing obstruction on adjacent vessels. Among the 12 patients with attempted TCPDA, five had surgery on a median of 3 days after TCPDA and seven had a spontaneous PDA closure within a median of 3 days after the procedure. Only the shape of the PDA differed between the surgical ligation group (short and conical) and spontaneous closure group (F-type); (4) Conclusions: In the case of TCPDA failure, mechanically induced spontaneous closure may occur early after the procedure. Surgical ligation should be postponed when clinically tolerated.

Robotic, totally endoscopic atrial septal defect repair

Atrial septal defect accounts for 10–15% of congenital heart disease cases. Small-diameter atrial septal defects diagnosed during infancy or early adulthood are prone to spontaneous closure, whereas uncorrected, persistent moderate or large atrial septal defects can induce left-to-right shunting, which causes volume overload, heart failure, atrial arrhythmia, and/or pulmonary hypertension starting between the third and fourth decades of life. We describe in detail our technique for totally endoscopic, robotic-assisted atrial septal defect repair.

Effect of Placing Double-lumen Irrigation-suction Tube on Spontaneous Closure of Anastomotic Leakage Following Rectal Cancer Surgery

Purpose: This study aimed to explore the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the spontaneous closure of anastomotic leakages (AL) after rectal cancer surgery. Methods: The study was performed at two centers which was managed by the same chief. The treatment in the two center were same. From January 2011 to June 2020, patients with postoperative AL after rectal cancer surgery were eligible. Patients were divided into a passive drainage (PD) group and a DLIST group according to whether the PD,placed during the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated.Result: There were 76 patients in the DLIST group and 52 in the PD group. The DLIST group was more inclined to achieve spontaneous closure of AL (HR =3.048; 95% CI: 1.787-5.197; P<0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 [41.25-117] days vs. 112 [66.75-127.75] days, P =0.005; and $18,721 [$14,982-44,960] vs. $40,840 [$20,932-50,529], P < 0.001).Conclusion: Placement of DLIST is an effective method for treating AL following rectal cancer surgery. Compared with PD, the cost of DLIST in the treatment of AL is lower and the length of stay is shorter.

Spontaneous closure of degenerative lamellar macular hole with epiretinal membrane proliferation

Background To describe the spontaneous closure of a degenerative lamellar macular hole with epiretinal proliferation (LHEP) as documented with tracked spectral domain optical coherence tomography (SD-OCT). Case presentation A 54-years-old diabetic female patient presented with progressive vision loss in the left eye. SD-OCT illustrated LHEP associated with cystic fluid in the outer nuclear layer. Sequentially tracked SD-OCT showed progressive closure of the degenerative lamellar macular hole and resolution of the CME over almost 4 years, in the absence of any surgical intervention. Discussion/conclusion LHEP may represent a specialized form of degenerative epiretinal membrane associated with Muller cell activation. Spontaneous degenerative LMH closure may rarely occur with these lesion types, in the absence of surgical intervention, possibly due to Muller cell proliferation preceded by PVD.

A Comparison of Residual Shunts After Two Different Surgical Methods for Isolated Ventricular Septal Defect Closure

BackgroundTo examine residual defects(RS) and examined the rate of spontaneous RS closure over time to identify factors associated with the occurrence and spontaneous closure of these defects after two different operation methods.MethodsIn this retrospective analysis, we enrolled only patients with perimembranous VSDs (pmVSDs) and reviewed the clinical records of patients who underwent repair for pmVSDs between January 2016 and January 2019. All patients underwent surgery with either cardiopulmonary bypass (the CPB group) or minimally invasive closure of transthoracic VSDs under the guidance of TEE (the MIC group). There were 189 patients who underwent CPB surgery and 211 patients who underwent MIC surgery. Ultimately, there were 37 patients with RSs in the CPB group (surgical repair via CPB) and 39 patients with RSs in the MIC group (minimally invasive closure of transthoracic VSDs). Postoperatively, all surgical patients were required to return for outpatient follow-up visits, and echocardiography was required to evaluate the RS. Assessments included shunt velocity and RS size.ResultsIn the CPB group, 16 patients had a small RS, and 21 patients had a moderate RS. The comparison between the variables such as weight, preoperative VSD size, and RS size revealed no significant differences except RS size (P=0.000). To compare the spontaneous closure rates of the two sizes of RSs(the moderate group and small size group), Kaplan-Meier plots were used. These plots show that the small size was more likely to undergo spontaneous closure (P=0.034), but the final spontaneous closure rate was not significantly different (P=1.000).In the MIC group, there were 29 patients in the small group and 10 patients in the moderate group, and the variables such as weight, preoperative VSD size, and preoperative VSD size showed no significant differences except RS size and the rate of no spontaneous closure (P=0.000 vs. 0.045). The Kaplan-Meier plots (Figure 2) showed that the small size was RSs were more likely to undergo spontaneous closure (P=0.004), while the final spontaneous closure rate was significantly different between groups (P=0.045).At 2 years post-operation, 7 patients still had RSs, and the overall spontaneous closure rate was 90.8%. The size of the RS on discharge was the only variable identified, on Cox regression, to be predictive of the likelihood of spontaneous closure. The univariate analysis, however, showed that shunt velocity had no association with spontaneous closure. Factors including age, weight, sex, surgical technique, and VSD size had no association with spontaneous closure.ConclusionThe RS incidence and spontaneous closure rates were not significantly different two different operation methods. Small RSs were more likely to undergo spontaneous closure in both groups.

Spontaneous Closure of a Carotid-cavernous Fistula after Contrast-enhanced Orbit Computed Tomography

Purpose: We report a case of spontaneous closure of a carotid-cavernous fistula (CCF) after contrast-enhanced orbit computed tomography (CT).Case summary: A 80-year-old female was referred to our clinic under suspicion of chronic angle- closure glaucoma because of persistently high intraocular pressure commencing one month prior. Slit-lamp examination revealed a conjunctival injection and corkscrew-like vessel dilatation in the left eye, and a high intraocular pressure. Dilated fundus examination revealed central retinal vein occlusion in that eye. Contrast-enhanced orbit CT revealed a dilated, superior ophthalmic vein in the left orbit, and she was transferred to our department of neurosurgery for digital subtraction angiography (DSA); this is the gold standard imaging modality for the diagnosis of direct and indirect CCFs. DSA was performed two weeks after orbit CT; however, no CCF was visible. Thereafter, the conjunctival injection and the elevated intraocular pressure improved gradually over eight months. We suspect that the CCF closed spontaneously.Conclusions: Our case highlights the fact that a CCF can close spontaneously after contrast-enhanced orbit CT; ophthalmologists may wish to bear this in mind.

Gallstone Ileus with Resolution of Bile Leak Post-Subtotal Cholecystectomy and Spontaneous Closure of Cholecystoduodenal Fistula: Case Report and Literature Review

Gallstone ileus (GSI) is a mechanical intraluminal bowel obstruction caused by biliary calculi through the biliary-enteric fistula. This is a rare sequela of cholelithiasis occurring in 0.3 – 1.5% of patients with worrying mortality of 11.7 – 20%. This is a case of GSI in a 67-year-old woman who presented with small bowel obstruction secondary to impaction of biliary calculi at terminal ileum with underlying cholecystoduodenal fistula (CDF). Enterolithotomy with stone extraction (ES) was performed, followed by subtotal reconstituting cholecystectomy due to iatrogenic gallbladder perforation. The diagnosis of GSI is ascertained by the presence of the Rigler’s triad on abdominal X-ray, while CDF was demonstrated by post-surgery CT images. Bile leak post-operation was managed conservatively based on the SNAP (Sepsis, Nutrition, Anatomy, Plan) approach, and spontaneous closure of CDF was observed. In a nutshell, GSI should always be kept in mind as a differential diagnosis of mechanical bowel obstruction, especially among elderly female patients. Radiological findings of Rigler’s triad aid clinical diagnosis of GSI. Despite its rare incidence, early diagnosis is crucial as it is readily treatable with surgery. ES alone is the gold standard in the management of GSI.