Severe loss and recovery of vision after glaucoma filtration surgery.

PURPOSE: To report a case of sudden, severe, unexplained, bilateral loss of vision after glaucoma filtration surgery in both eyes; the vision returned 2 months later. METHODS: The clinical records of the patient were reviewed retrospectively. Observations were made and collated as the case progressed. RESULTS: A 25-year-old man previously diagnosed with poorly controlled, far-advanced, juvenile-onset primary open-angle glaucoma underwent bilateral guarded filtration procedures. Preoperative visual acuity was 20/40 in the right eye and 20/100 in the left eye. After the procedure visual acuity was severely diminished to no light perception in the right eye and light perception in the left eye. There was no apparent cause for the visual reduction other than the decrease in intraocular pressure caused by the surgery. Two months postoperatively, the patient had visual acuity of 20/80 in the right eye and 20/200 in the left eye. Ten months postoperatively, visual acuity was 20/70 in the right eye and 20/200 in the left eye. Twenty-three months postoperatively, visual acuity was 20/100 in the right eye and 20/200 in the left eye. CONCLUSIONS: This case provides evidence for the potential reversibility of severe visual loss after glaucoma filtration surgery.

Comparative study of 3 techniques to detect a relative afferent pupillary defect.

PURPOSE: To compare the standard method of testing for a relative afferent pupillary defect (RAPD) using the Standard Swinging Flashlight Method (S-SFM) with 2 novel techniques, to evaluate the validity and reproducibility of each method, and to validate the clinical significance of detecting more subtle RAPDs by correlating the extent of glaucoma damage with the presence or absence of an RAPD as assessed by each method. PATIENTS AND METHODS: In this prospective, observational study 101 consecutive patients (68 diagnosed glaucoma patients, 20 glaucoma suspects including ocular hypertensives, and 13 controls) were screened for the presence or absence of an RAPD using the S-SFM, Magnifier-Assisted Swinging Flashlight Method (MA-SFM), and Ophthalmoscopic Swinging Flashlight Method . Humphrey visual field mean deviation (MD) of each eye and the intereye differences in MD and Disc damage likelihood score (DDLS) and intereye difference in DDLS were calculated. Sensitivities for each method (S-SFM, MA-SFM, and Ophthalmoscopic Swinging Flashlight Method) were calculated at increasing levels of change in DDLS and MD. Weighted κ scores were calculated for agreement between tests. RESULTS: MA-SFM is the most sensitive method for determining an RAPD in terms of both intereye difference in DDLS and intereye differences in MD at all levels of change. Weighted κ scores revealed substantial agreement between tests for the same method, and moderate to substantial agreement among the observers. CONCLUSIONS: This study confirms results of our earlier study suggesting that swinging flashlight test modified with magnification (MA-SFM) can provide a simple, inexpensive, reproducible method of detecting an RAPD.

Two Arabidopsis orthologs of the transcriptional coactivator ADA2 have distinct biological functions.

Histone acetylation is an example of covalent modification of chromatin structure that has the potential to regulate gene expression. Gcn5 is a prototypical histone acetyltransferase that associates with the transcriptional coactivator Ada2. In Arabidopsis, two genes encode proteins that resemble yeast ADA2 and share approximately 45% amino acid sequence identity. We previously reported that plants harboring a T-DNA insertion in the ADA2b gene display a dwarf phenotype with developmental defects in several organs. Here we describe T-DNA insertion alleles in the ADA2a gene, which result in no dramatic growth or developmental phenotype. Both ADA2a and ADA2b are expressed in a variety of plant tissues; moreover, expression of ADA2a from a constitutive promoter fails to complement the ada2b-1 mutant phenotype, consistent with the hypothesis that the two proteins have distinct biochemical roles. To further probe the cellular roles of ADA2a and ADA2b, we studied the response of the transcriptional coactivator mutants to abiotic stress. Although ada2b seedlings display hypersensitivity to salt and abscisic acid and altered responses to low temperature stress, the responses of ada2a seedlings to abiotic stress generally parallel those of wildtype plants. Intriguingly, ada2a;ada2b double mutant plants display an intermediate, gcn5-like phenotype, suggesting that ADA2a and ADA2b each work independently with GCN5 to affect genome function in Arabidopsis.