Vertical tripod fixation (VTF) simplifies transscleral approaches.

Transscleral fixation of intraocular lenses (IOL) is an accepted procedure today. Following Malbran's initial approach, new techniques have been developed in various ophthalmic centers; many, however, are time-consuming and difficult, as reflected by complications, most commonly hyphema and IOL tilt. We present here a simple method of transscleral fixation, which was performed in 24 patients in our department. It involves fixating the IOL vertically, on a three-point configuration, using standard 10-0 prolene stitches. Performing it is easy and time-saving. VTF ensures a stable transscleral fixation of an IOL.

Procedures involving star-shaped capsulectomy for managing congenital cataracts in developing nations.

The management of congenital cataracts is still challenging, especially in developing nations, where surgical facilities are limited. Congenital cataracts were extracted from 22 patients (26 eyes): a procedure consisting of a star-shaped anterior capsulectomy and wash-out of lens material (STARWO) was performed in 16 of them (18 eyes) (group A); a procedure consisting of a star-shaped anterior capsulectomy, wash-out, anterior vitrectomy through the posterior capsulotomy, and repeated tearing of remnants of the anterior capsule (STARWAR) was performed in six patients (eight eyes) (group B). Intraocular lenses were implanted in both groups. In group A, secondary membranes (27.7%) developed in five eyes, postoperative uveitis in four (22.2%), and a late Elschnig pearl in 1 (5.5%). In group B, there was one case of secondary membrane formation (12.5%), and one of postoperative uveitis; neither required subsequent intervention. The inexpensive instrumentation used and the low rate of perioperative complications encountered in these patients make these two techniques attractive alternatives for managing congentital cataracts in developing nations.

[Diffuse corneal pigmentation--a new sign in neurofibromatosis].

Neurofibromatosis is an autosomal dominant disease affecting many organs. It is known for the characteristic pigmented skin spots and various neurofibromas. We present a 79-year old man who underwent elective cataract extraction. The surgery was complicated by the presence of diffuse, deep, intracorneal pigmentation. To our knowledge, this sign has not as yet been described in neurofibromatosis.

The "lock-and-valve" incision: truce in the "suture wars".

We describe a variation of the "classical" cataract incision that uses midsize incisions and standard instrumentation. Perpendicular entrance and oblique cut create an acute angle with the iris plane, generating an intracorneal valve. This results in better apposition of the wound's lips and less responsiveness to variations in intraocular pressure; thus, fewer stitches are required. We have achieved favorable results in 16 patients using this type of incision.

Conservative management of the Kasabach-Merritt syndrome (cavernous haemangioma and thrombocytopenia).

Two neonates with the Kasabach-Merritt syndrome (cavernous haemangioma and spontaneous bleeding) are described. The first bled into a rapidly growing cervical haemangioma. A consumptive coagulopathy was found, and he required blood transfusions; no response to steroids was observed. Further treatment was conservative, and at the age of 2 years he is well and the haemangioma is shrinking. The second infant had a strawberry naevus on the thigh which started bleeding when he was 10 days old, a buttock mass and a mass in the foot, thought to be lipomas. No clear benefit was derived from steroids. Bandaging of the thigh prevented further bleeding, and he is well at the age of 10 months. Conservative management seems best in the condition, and steroids appear to be of value in approximately 40% of cases.

Occurrence of primary hepatocellular cancer and peliosis hepatis after treatment with androgenic steroids.

Three patients are reported in whom treatment of Fanconi's anaemia with androgenic steroids was complicated by the development of either primary hepatocellular cancer (PHC) or peliosis hepatis. The first, a White woman aged 34 years, was found to have PHC after receiving first methyltestosterone and then oxymetholone for a total period of 7 years. She died 4 months after the diagnosis was made. The other 2 patients were White children who presented with peliosis hepatis after receiving methyltestosterone and oxymetholone for 8 years and oxymetholone for 5 years, respectively. Both died from their primary diseases shortly after oxymetholone treatment was discontinued. Possible pathogenic mechanisms involved in the development of these serious complications are discussed and the therapeutic dilemma raised by their occurrence is emphasised.