AIM:To estimate the safety and advantage of upper peribulbar anesthesia and topical anesthesia in extra capsular cataract extraction(ECCE) and intraocular lens(IOL) implantation. METHODS: All the 286 patients(301 eyes) with cataract from June 2005 to December 2008 were randomly assigned to three groups: group A(126 eyes) under upper peribulbar anesthesia and topical anesthesia; group B(89 eyes) under infra-conjunctival anesthesia;group C(86 eyes) under retrobulbar anesthesia. All the surgeries were under the microscope. The time of follow-up was 3 days. The effectiveness of anesthesia in operation, postoperative visual acuity and conjunctival reaction 3 days after operation were surveyed. RESULTS: The effectiveness of anesthesia in operation was good, these in group A and C were better than that in group B;postoperative visual acuities in group A and B were better than that in group C;conjunctival reaction in group A and group C were better than that in group B. CONCLUSION: ECCE and IOL implantation with upper peribulbar anesthesia and topical anesthesia is safe and superior to the infra-conjunctival anesthesia, topical anesthesia and retrobulbar anesthesia.