AIM: To explore the clinical efficacy and safety of small incision non-phacoemulsification under topical anesthesia on cataract patients over the age of 90. METHODS: Twenty-four cases (25 eyes)of hyper old cataract patients were selected and they underwent small incision non-phacoemulsification and intraocular lens implantation. RRSULTS: All patients were performed smoothly operation by physicians. 17 eyes (68%) got a visual acuity of 0.6 or more 3 months after operation, of which 12 eyes (48%) got a visual acuity of 0.8 or more. No serious complications occurred and the effects were satisfactory. CONCLUSION: The careful examinations of the body and eyes before operation, especially the conditions of corneal endothelium and nuclear hardness, were the guarantee of success of the small incision non-phacoemulsification under topical anesthesia.