Eyeworld

60 | EYEWORLD | SEPTEMBER 2023 G UCOMA by Manjool Shah, MD Glaucoma Editor O ne of the pleasures of working in academic medi- cine is the ability to collaborate at a high level with non-medical colleagues. In a recent conver- sation about glaucoma surgery I had with colleagues from NYU's School of Engineering, we found ourselves discussing ways to evaluate, modify, and potentially design safer surgical devices. In a post-meeting wrap- up message, one of the lead engineers told me he was struck by something I said: "The physics only get you so far. The chaos of the human body, the craft of a surgeon's hand—that's where medicine lives." Surgical successes often need not be ex- plained; we all expect the expected outcome and therefore shouldn't be surprised when a pa- tient's surgical course progresses as we thought it would. However, when things don't quite go the way we intended, we are often at a loss. Understanding the root causes, pathophysiology, and (dare I say) physics of the mechanisms of failure is without a doubt instrumental in not only navigating the murky waters of recovery after complications but preventing unwanted surprises in the first place. Putting this knowl- edge into the randomness generator that is medicine is where we all get to be artists. In this issue of EyeWorld, we get into the real challenges of surgical glaucoma. From a discussion of everyone's Friday evening clinic showstopper, neovascular glaucoma, through complications of MIGS, to a conversation about the dreaded and often mischaracterized malig- nant glaucoma, our contributors consider first principles in their recommendations for diagno- sis, management, and prevention. My residents and fellows sometimes get sick of hearing me say this, but I'll subject you all to one of my intraoperative refrains: "Compli- cations are gold—embrace them!" Fortunately, they are rare. As such, treat them as the mines of educational opportunity that they are. As we all strive to practice better medicine, take the time to dig deeply into your missed opportuni- ties and suboptimal results; it is in these rare events that we push to new heights. Real challenges of surgical glaucoma As we all strive to practice better medicine, take the time to dig deeply into your missed opportunities and suboptimal results; it is in these rare events that we push to new heights.

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