AIM:To investigate the surgically induced refractive change after phacoemulsification with selective maximum astigmatic axis clear corneal incision.METHODS:All 96 cases (112 eyes) with cataract were randomly divided into three groups,group A received temporal transparent corneal incision (34 cases,39 eyes);group B received transparent corneal incision at 11 O’clock(26 cases,31 eyes);group C received highly selective transparent corneal incision at steepest corneal meridian guided by corneal curvature (36 cases,42 eyes).RESULTS:There was no statistically significant difference in visual acuity in three groups before and 1 week after operation (P>0.05).The visual acuity in group C was much better than that in group A and B before and 1 month,3 months after operation (P<0.05),but there was no statistically significant difference between group A and B(P>0.05).The corneal astigmatism degree of group C was much lower than that of group A and B 1 month and 3 months after operation (P<0.05).CONCLUSION:The incision at the steepest corneal meridian guided by corneal curvature has the least effect on corneal astigmatism and can improve visual acuity rapidly.The surgically induced astigmatism can be controlled effectively and patients can gain better visual acuity.