Surgery for glaucoma in the 21st century. (Glaucoma).

How close are we to a utopian world?

Many of us who were brought up in the latter half of the 20th century will recall reading and watching science fiction programmes in the media predicting life in the 21st century. Apart from a life of leisure facilitated by intelligent computers and robots, we were meant to enjoy a prolonged life because of advances in science and technology. The few of us who did not have our genetic defects and predisposition to various diseases ironed out by the new "molecular surgery" would enjoy surgical correction with advanced technology including magic scalpels which left no scar. The surgery itself would be quick, have minimal complications, and require no postoperative care and manipulation, achieving the desired surgical "end point" in 95-100% of cases. Cataract surgery is nearly there, so how close are we to this utopian world with regard to glaucoma surgery?

In this issue of the BJO (p 748) O'Brart and colleagues report their randomised prospective study comparing viscocanalostomy with antimetabolite assisted trabeculectomy. In theory, the operation of viscocanalostomy is claimed to bring us one step closer to the restoration of normal drainage by dilating (with viscoelastic) and facilitating flow round Schlemm's canal without macroscopically penetrating the eye. (1) There is some evidence that the dilatation of Schlemm's canal can be achieved at least for a short period with a viscoelastic injection, although the value of this is uncertain.

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