Vision “wipe-out” phenomena following a nonincisional laser procedure in the management of narrow-angle glaucoma

Abstract

The “Wipe-out” or “Snuff-out” phenomenon refers to a permanent and severe loss of vision without an identifiable cause and is considered a rare but dreaded consequence of incisional ocular surgery. It is believed to occur in patients with advanced glaucoma who demonstrate a residual central island of vision. A 42-year-old female patient presented to the general ophthalmology clinic with complaints of painless blurring of vision of the left eye for 8 months. Best-corrected visual acuity (BCVA) was 20/30 and 20/40 and intraocular pressure (IOP) was 26 mmHg and 28 mmHg in the right and left eyes, respectively. Relative afferent pupillary defect was noted in the left eye. Anterior segment examination showed peripherally shallow anterior chamber and gonioscopy revealed appositionally closed angles (Shaffer-<20 Deg) in both eyes. Fundus examination showed advanced glaucomatous optic neuropathy of the left eye. Generalized depression in the right eye and inferior arcuate scotoma with a superior nasal step, and split fixation in the left eye was seen on Humphreys 30-2 visual fields. A diagnosis of chronic primary angle closure glaucoma was made and the patient was offered Nd: Yag Laser Peripheral Iridotomy (LPI). LPI was completed for the right eye and Argon Laser Iridoplasty was performed in the left eye as Iridotomy was not possible due to the proximity of the iris to the cornea as the pupil was mid-dilated. After the procedure, the patient was prescribed topical antiglaucoma medications with topical steroids at 1 week follow-up, the patient had BCVA of 20/30 in the right eye and hand motion in the left eye, IOPs were well controlled on topical anti-glaucoma medication. A thorough examination including a dilated fundus examination, B-Scan ultrasound, and fundus fluorescein angiography were unremarkable. Magnetic resonance imaging scan of the brain and orbits was normal. “Wipeout” phenomenon is a rare but notorious complication associated with incisional surgeries in patients with advanced glaucoma. It is also reported to occur following cataract and retinal incisional surgeries. There are no reports of a wipe-out after a commonly performed laser procedure.