The advisability of removing the conjunctival flap, as advocated by Dr. Wood, as a modification of the Lagrange operation, may be seriously questioned, for aside from the fact that apparently no advantages in aiding permanent filtration are added, there is, added to the objections to the Lagrange operation already mentioned, the very serious disadvantage of subjecting the area at the root of the iris to infection for a prolonged period of time. The advantages of the protection afforded by a conjunctival flap far outweigh the disadvantages of a remotely possible interference of drainage by the blocking of the open wound with conjunctival tissue. The fortunate experience of Dr. Wood in not having infection in a wound which remains open and unprotected for variable lengths of time is not likely to be the experience of any considerable number of operators, and probably will not always be the experience of Dr. Wood. Furthermore, the possibilities of damage by hemorrhage from the choroidal or retinal vessels, delayed formation of the anterior chamber and adhesion of the capsule of the lens to the wound, and the injurious effects of even slight trauma subsequent to the operation, including loss of vitreous, are increased by omitting the conjunctival flap. The modern operation for the relief of glaucoma, by which a filtering scar is produced which permits escape of liquid from the anterior chamber, is the one which apparently holds out the most hope of permanently relieving the condition. While success will depend always to a certain extent upon the personal equation, yet it seems now that for a large majority if not all of the cases we are justified in abandoning all other operations than trephining, notwithstanding the verdict of Elschnig and others that fistula forming operations eventually will be discarded in favor of iridectomy and cyclodialysis. Late or secondary infection, not unknown following iridectomy, may follow the trephine operation, and already some fifteen or sixteen cases have been reported. But while this possibility is a real danger, which improved technique may greatly minimize (Col. Elliot has not seen a case of secondary infection in an experience of over 1200 trephining cases of his own and a large number of others performed by his assistants and pupils) the ultimate verdict must rest with results as compared with other measures. At present, as pointed out by Meller, whose statistics Dr. Wood has cited, trephining heads the list of remedial measures for the relief of glaucoma, and it has the advantage of being applicable to any form of the disease, to be relatively free from danger, either immediate or remote, and to produce the highest percentage of favorable results. The addition of an iridectomy in every case of trephining does not unduly complicate the operation and has much to commend it in offering the patient every possibility of relief. INDEX