Should We Fear Wipe-Out in Glaucoma Surgery?

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Vision Science

Background:

• Wipe-out is a severe complication of glaucoma surgery, causing sudden, irreversible central vision loss.
• It typically affects patients with advanced glaucoma and compromised optic nerves.
• Understanding its incidence, risk factors, and mechanisms is crucial for patient safety.

Purpose of the Study:

• To critically assess the current incidence, risk factors, pathophysiological mechanisms, and clinical relevance of wipe-out syndrome.
• To review contemporary data on wipe-out following glaucoma surgery.
• To evaluate the impact of modern surgical techniques on wipe-out risk.

Main Methods:

• A comprehensive literature review of peer-reviewed studies was conducted.
• Databases searched included PubMed, Medline, and Google Scholar up to 2025.
• Analysis focused on incidence, risk factors, mechanisms, and prevention strategies.

Main Results:

• Historical wipe-out incidence ranged from <1% to 13%; current incidence is frequently below 1%.
• Key risk factors include severe visual field loss, older age, postoperative hypotony, and optic nerve compromise.
• Modern MIGS and refined trabeculectomy show lower wipe-out risks compared to older methods.

Conclusions:

• Wipe-out syndrome, while serious, has a minimal incidence in contemporary glaucoma surgery.
• Preventive measures include careful patient selection and optimized surgical techniques.
• The benefits of modern glaucoma surgery, particularly MIGS, outweigh the minimal risk of wipe-out.