·AIM:To investigate the effect of small incision non-phaco extracapsular cataract surgery in the treatment of hard nuclear cataract with small pupil.·METHODS:The clinical data of 156 patients 173 eyes with small-pupil hard nuclear cataract who underwent small incision non-phaco extracapsular cataract surgery were retrospectively analyzed.The patients were followed up for 12 months.Postoperative best-corrected visual acuity(BCVA),pupils,intraocular lens(IOL),intraoperative and postoperative complications were observed and analyzed in the follow-up period.·RESULTS:After 6 months postoperatively,BCVA was achieved ≥0.05 in 143 eyes(82.7%),among which ≥0.3 in 101 eyes(58.4%).Compared with preoperative ones,visual acuity was significantly improved,the difference was significant(χ2=169.17,P<0.01).Although the rupture of posterior capsule occurred in 11 eyes(6.4%)intraoperatively,the operations were all fulfilled and IOL implantations were performed.Postoperatively,transient high intraocular pressure occurred in 9 eyes(5.2%)and mostly recovered with in 1 week after the medication;corneal edema was presented in 29 eyes(16.8%)and healed within 7 days;the inflammation in the anterior chamber and hyphema were mild and recovered to normal in 2 to 12 days.Retinopathies were observed in 88 eyes(50.9%)postoperatively.The causes of small pupil included:diabetes in 86 cases(55.1%);chronic uveitis in 39 cases(25.0%);chronic uveitis combined with diabetes in 22 cases(14.1%);angle-closure glaucoma with long period of medication of miotic eyedrops in 5 cases(3.2%);pupillary defect with unknown causes in 4 cases(2.6%).·CONCLUSION:The effect of small incision non-phaco extracapsular cataract surgery in the treatment of hard nuclear cataract with small pupil is very significant,which should be promoted in primary hospital with high security and few complications.The key to intraoperative procedure is to manage the small pupil.The main cause of the poor postoperative visual acuity is vitreoretinopathy.The causes of small pupil are diabetes and chronic uveitis.·