This article examines the influence of the No Child Left Behind Act on the decision making of rural principals and teachers about curriculum and instruction as well as the possible long-term effects on rural education. Data were gathered from 101 rural elementary school principals in Missouri and 76 rural elementary school teachers in Maine. Missouri principals were concerned about losing their autonomy and abilities to be instructional leaders. Maine teachers reported that NCLB benefited some groups of students more than others and that it has a negative effect on student motivation. There were significant changes in instructional time for some subjects and non-instructional time for recess and kindergarten nap time. The most important influence on principals’ educational vision for the future and the need for professional development was meeting AYP and raising test scores.

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Ciliary block or malignant glaucoma is thought to be caused by the misdirection of aqueous into the vitreous. It is refractory to medical treatment and often requires vitreous aspiration. We present a case of ciliary block glaucoma caused by sodium chondroitin sulfate-sodium hyaluronate (Viscoat) gaining access to the vitreous through an unsuspected, small zonular dialysis. Vitrectomy performed through a peripheral iridectomy resolved this severe condition.

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