AIM:To evaluate the operative ways and efficacy by comparing the safety and effectiveness of two kinds of surgery and postoperative visual acuity,postoperative complications in hard nucleus cataract.METHODS:Selected 79 cases 84 eyes of hard nucleus cataract grade Ⅳ-Ⅴ from the patients of 2009 to 2010,aged 60 to 80,who fell ill for 8 to 15 years,were randomly divided into phacoemulsification group for 42 eyes,small incision with non-phacoemulsification group for 42 eyes,visual acuity was compared the first day,the third day,1 week,1 month after the surgery respectively,corneal astigmatism and the density of corneal endothelial cells were observed 1 week,1 month after the surgery respectively,and postoperative complications during and after the surgery respectively.RESULTS:All the 84 eyes were followed-up for 0.5 to 24 months,an average of 15 months.Small incision phacoemulsification group recovered better in visual acuity than phacoemulsification group after the first day and the third day,there was significant difference(P<0.05).There was no significant difference after 1 week and 1 month;corneal astigmatism was smaller in phacoemulsification group than that in small incision phacoemulsification during 1 week after the operation,there was significant difference(P<0.01),and there was no significant difference during 1 month.The density of corneal endothelial cells was less in phacoemulsification group than that in non-phacoemulsification group during 1 week and 1 month after the operation,there was significance difference(P<0.05).It was severer in the postoperative complications such as corneal edema,aqueous flare of phacoemulsification group than that of small incision non-phacoemulsification group,there was significant difference(P<0.05).CONCLUSION:The small incision non-phacoemulsification is safer and more practical for treating hard nuclear cataract,and recovers better in visual acuity with minimal invasion.It is user-friendly and low cost.And the complications of small incision are less.