=Second step.= _Iridectomy._ The patient is made to look downwards. A pair of iris forceps are inserted, closed, into the anterior chamber, opened, and the iris grasped near its root, and withdrawn. The piece of iris is then removed with the iris scissors, dividing it parallel with the incision as close to the eye as possible (Fig. 97). If the conjunctival flap hinders the insertion of the iris forceps into the anterior chamber, it may be turned forward over the cornea with the point of the closed forceps. =Third step.= _The capsule of the lens is opened._ This is done in order to allow the lens nucleus and soft matter to escape. Since the anterior capsule becomes opaque after the removal of the lens, owing to the multiplication of the cells in their attempt to lay down new lens fibres, it is desirable to remove a portion of the anterior capsule from the pupillary area. This may be performed (_a_) by means of capsule forceps which are inserted closed, and when in position over the lens are opened as widely as possible without entangling the iris, then pressed down on to the anterior capsule of the lens and closed; in this manner the portion of the capsule thus included is removed by a slight lateral movement (Fig. 98); (_b_) by means of a cystotome, the lens capsule being opened by a triangular or T-shaped incision over the pupillary area; (_c_) by the point of the knife as it passes across the anterior chamber; (_d_) by a discission needle before the section is made. When the capsule of the lens has been opened properly the lens nucleus is usually seen to come forward. The advantage of the capsule forceps over the other methods is that they remove a larger portion of the capsule and leave no tags which may become incarcerated in the wound. On the other hand they are somewhat more difficult to use; more pressure on the lens is required, and therefore dislocation of the lens in its capsule may result. It is, therefore, not advisable to use them in cases in which a fluid vitreous is suspected. If the teeth of the forceps are not well made they will not grasp the capsule; it is therefore always advisable to have the cystotome in readiness. The cystotome also should be used when the anterior chamber becomes filled with blood so that the margin of the iris cannot be seen and there is a risk of the iris being grasped by the forceps. [Illustration: FIG. 97. INCISION AND IRIDECTOMY IN CATARACT EXTRACTION.] The method of opening the capsule with the point of the knife or needle is useful in cases of extraction without iridectomy; the pupil should be dilated before the operation. =Fourth step.= _Delivery of the lens_ is performed by a gentle pressure, combined with massage, on the extreme lower margin of the cornea with a curette or spoon, until the upper margin of the lens presents in the wound, when the pressure is gradually made upwards over the cornea until the lens is delivered. Delivery of the lens may be prevented by--