[Illustration: Fig. 47, (Case 4).--Iridotomy with round central pupil in a resilient iris-membrane.] CAPSULOTOMY BY THE V-SHAPED METHOD. The application of the V-shaped method to capsulotomy shows an even greater field of usefulness, as this method is par excellence the best way of incising a delicate secondary capsular cataract. This should be done under artificial illumination. The pupil should be dilated, as the area of incision is necessarily smaller than in iridotomy, and unnecessary wounding of the iris should be avoided. The proposed capsular opening must be so calculated as to fall within the area of the undilated pupil, or partly within the coloboma if an iridectomy has been previously performed. [Illustration: Fig. 48.--Author’s V-shaped capsulotomy. Plan of first incision.] [Illustration: Fig. 49.--First incision completed. Plan of second incision.] [Illustration: Fig 50.--Pupil resulting from V-shaped capsulotomy.] The knife-needle is entered at the upper corneal margin, passed across the anterior chamber to a point 2 mm. to the left of the vertical plane (Fig. 48), the capsule punctured by a quick thrust, and the saw-like incision carried from below upward, as in iridotomy. The knife is then raised up above the capsule and swung 3 mm. to the right of the vertical plane (Fig. 49), the capsule is again punctured, and a duplicate incision carried up to join the first, at the apex of the converging V (Fig. 50). Where the pupillary margin is adherent to the underlying capsule, or the pupillary space is too small, it may be necessary to start the incision in the iris tissue, a little below the pupil, and then cut upward until the knife emerges into the pupillary area, thus making an irido-capsulotomy. The soft iris tissue is easily incised if no pressure is made with the knife, and the sawing motion is maintained. AFTER-TREATMENT. Postoperative inflammatory reaction is infrequent, but if it should occur the usual antiphlogistic treatment of atropin, calomel, ice-pads and leeching should be actively instituted and continued until the eye is absolutely quiet. The operation itself is frequently an antiphlogistic measure, because it relieves iris-tension and traction on the ciliary body. The usual compress of gauze and cotton, covered with a Liebreich patch, may be applied to the eye for the first twenty-four hours and rest in bed enjoined for that period. IN CONCLUSION.