In Einstein’s universe, time is viewed as a static four-dimensional block, where the past, present, and future coexist simultaneously. As he posits, every event that has happened or will happen sits at its own fixed coordinate. This concept has been likened to a loaf of bread—every slice a moment, the whole loaf already baked. The present is only where we happen to be standing, from our unique perspective.
A stranger corollary emerges from the theory of special relativity: No two observers fully agree on which events are happening “now.” Because the speed of light is constant, two observers moving at different velocities will slice the block along different planes. Two events that one records on separate slices—at different times—another may record on a single slice, as if simultaneous. The events have not changed, only the frame of reference (or angle at which the bread is sliced) has.
The same is true of how we define an operation. Frame only the procedure in the OR, and the surgery is a distinct event, from incision to last stitch. By that slicing, a needling procedure, an OVD injection, laser suture lysis, a steroid taper, an eye drop to blunt a hypertensive phase all read as complications or interventions: unwelcome intrusions on an operation already finished.
Adjust the frame, and these events read differently. Experience shows us that a surgery does not begin with the incision or end with the last stitch. It starts in the preoperative assessment and runs through every postoperative manipulation required to land the patient where we intended. These maneuvers are not failures of the operation but the operation itself—the means by which flow is tuned to its final outcome, the resultant IOP.
In this issue of GT, contributors walk through the nuances and postoperative interventions that, far from being afterthoughts, influence whether subconjunctival filtration surgery succeeds. Viewed through a wider frame, there are no complications, only the longer procedure, of which the operative portion is one part of a larger slice.
