AIM: To explore the use of scleral tunnel small incision and manual nuclear chopping in small pupil hard nucleus cataract extraction and foldable intraocular lens(IOL) implantation, and observe the postoperative clinical effects in patients.METHODS:Seventy cases 70 eyes underwent small pupil hard nucleus cataract extraction using a 5.5mm scleral tunnel in anti-superciliary arch posterior to corneal limbus, then they were implanted the foldable or PMMA IOL. The postoperative visual acuity, astigmatism degree as well as complications were observed.RESULTS:Of the 70 cases 70 eyes, 47 eyes(67%) with visual acuity≥0.5, 17 eyes(24%)≥0.8, and 5 eyes(7%)<0.25; the average corneal astigmatism of preoperative, 1 day, 1 week, 1 month was 0.35±0.29,0.42±0.33,0.39±032,0.37±0.30D, respectively. There was no significant difference in corneal astigmatism among the postoperative time points(P≥0.05). Intraoperatively, posterior capsular rupture occurred in 4 eyes(6%), hyphema in 5 eyes(7%), corneal edema in 6 eyes(9%), posterior synechia in 5 eyes(7%), increased tension in 5 eyes(7%) which was resolved after treatment, posterior capsule opacification in 6 eyes(9%) which recovered after treatment.CONCLUSION:The results suggest that the small pupil hard nucleus cataract extraction using scleral tunnel small incision and manual nuclear chopping overcome the drawbacks of long-term limbal incision, minimize the postoperative astigmatism, and improve the success rate of surgery, It requires no special equipment, and it is a simple easy method, it has the same effect as phacoemulsification, and it can effectively reduce the corneal astigmatism, get good vision, and reduce the cost of surgery.