Severe visual loss (wipe-out) following cataract surgery
Establishing the rate of severe visual loss (wipe-out) following cataract surgery - A surveillance study
Royal Free London NHS Foundation Trust Hospital
Duration of Study in the UK
3 years, 0 months, 1 days
Patients commonly develop cataracts. It has been reported that a sudden drop in central vision (wipeout) may occur in patients following cataract surgery. This is thought to be rare, and in a recent survey of contemporary glaucoma specialists, we found that 41 cases had been encountered in the UK over the last decade. These glaucoma specialists estimate the risk of wipeout at a variable rate, ranging from >1:100 to <1:1000.
Providing evidence-based information on the rate of wipeout and factors which may increase risks would assist patients in making decisions on cataract surgery and would inform the consent process.
Summary of Results
Background A sudden, irreversible reduction in visual acuity (‘wipe-out’) is a feared complication of cataract surgery. Current literature on wipe-out is limited in quantity and quality, and largely predates modern cataract surgery and imaging techniques. The objectives of our study were to estimate the incidence of wipe-out and to identify potential risk factors.
We prospectively collated cases of wipe-out occurring in the UK during a 25-month study period using the British Ophthalmic Surveillance Unit reporting system. A total of 21 potential cases of wipe-out were reported, 5 of which met all inclusion and exclusion criteria.
The estimated incidence of wipe-out during the study period was 0.00000298, or approximately 3 cases per million cataract operations. All cases of wipe-out occurred exclusively in patients with advanced glaucoma (mean deviation -21.0 decibels or worse in the operated eye), with an over-representation of black people (40%) in our case series. A prior diagnosis of retinal vein occlusion (60%) and elevated post-operative IOP (40%) were more common among individuals suffering from wipe-out compared to the general population, suggesting these factors may contribute to the pathogenesis of wipe-out.
Our study shows that wipe-out is a rare complication, affecting approximately 3 per million undergoing cataract surgery. Patients with advanced glaucoma, black patients, and those with previous retinal vein occlusions may be at greater risk of wipe-out. We hope that the findings of our study will be used to help inform treatment decision-making and the cataract surgery consent process.
North of Scotland Research Ethics Committee 1
Date of REC Opinion
22 Feb 2017
Further Information Favourable Opinion