Wipe-Out Phenomenon After Gonioscopy-Assisted Transluminal Trabeculotomy

To report the findings of a rare advanced pseudoexfoliation glaucoma patient with wipe-out phenomenon after gonioscopy-assisted transluminal trabeculotomy (GATT).

A 360-degree uneventful GATT was performed on a 71-year-old male patient with a history of uncontrolled diabetes mellitus. Sudden vision loss occurred and cystoid macular edema (CME) were detected in the early postoperative period. The CME regressed completely over 6 months but vision loss was irreversible.

At the preoperative visit, the best corrected visual acuity (BCVA) was 20/70, and intraocular pressure (IOP) was 36 mm Hg with maximum topical antiglaucoma medications (AGM) in his right eye. At the postoperative first-month visit, BCVA was hand motion, and IOP was 14.5 mm Hg with topical AGM. In addition, CME was detected. A topical nonsteroidal anti-inflammatory drug and oral carbonic anhydrase inhibitor were started to reduce CME. Since CME did not regress, 3 doses of intravitreal anti-VEGF injections were administered at 1-month intervals. At the postoperative sixth-month visit, BCVA was still hand motion, and IOP was 11.1 mm Hg with topical AGM. The CME was regressed completely but BCVA did not improve.

The sudden, unexplained, and irreversible vision loss attributed to the wipe-out phenomenon following GATT, should be taken into consideration when offering this procedure to patients with advanced glaucoma.