_Second step. Evacuation._ With the rush of aqueous which follows the incision some soft matter is usually evacuated; then a curette may be introduced, if necessary, and the lens fragments removed by gentle manipulation. Occasionally the iris may prolapse into the wound; if this happens it should be replaced, but if it occur more than once the prolapsed portion should be removed. Suction apparatus has been used for removing the soft lens matter, but it is not to be recommended in most cases, owing to the difficulty of sterilization and the trauma which it may cause. After-treatment as for needling should be carried out. EVULSION OF THE CAPSULE =Indications.= (i) In congenital cataract when the lens consists of little more than a dense capsular mass. (ii) In dense capsular membranes following removal of a lens by discission in which a cutting needle cannot make a hole. =Instruments.= Speculum, fixation forceps, keratome, capsule forceps, discission needle. =Operation.= A general anæsthetic is usually desirable. _First step._ The pupil is previously dilated with atropine. In the case of congenital cataract a discission needle is first passed into the mass to estimate its consistency. If it consist of little more than capsule an incision is made at the limbus with the keratome as described for evacuation. _Second step._ The blades of the capsule forceps are then inserted closed, opened, and the opaque capsule grasped and withdrawn from the eye. The speculum is then removed and a pad and bandage applied. The pupil should be kept dilated with atropine subsequently, as a certain amount of irido-cyclitis following the operation is not infrequent. Occasionally the iris may become entangled in the wound, and it should then be removed. EXTRACTION OF THE LENS =Indications.= (i) For all forms of cataract in patients over thirty years of age. (ii) For cases of high myopia over the same age. (iii) For lenses containing foreign bodies. (iv) For displacement of the lens causing irritation. Probably no operation in surgery has so many modifications, many of which possess advantages and disadvantages which counterbalance each other so nearly that the individual surgeon must decide for himself which is the most satisfactory to carry out. The opinion of many surgeons, including the author, is that the ideal operation is one which can obtain sight for the patient at one sitting. The operation described below is carried out with this object in view, the various modifications and the indications for their use being subsequently discussed. _Instruments._ Speculum, two pairs of fixation forceps, a Graefe’s knife, iris forceps (Fig. 90), iris scissors (Fig. 91), capsule forceps, cystotome, curette or spoon, iris spatula, vectis (Fig. 92), or lens spoon (Fig. 93). =Operation.= The operation is performed under cocaine and is divided into five steps:--