AIM: To observe the clinical surgical effect of brown hard nuclear cataract, and discuss the surgical skills.

METHODS: Totally 80 eyes of 80 patients with level V cataract were randomly stratified, divided into two groups. We operated with sclera tunnel incision phacoemulsification in Group A(40 eyes), combined with manual cataract extraction. Sutureless large-incision-manual cataract extraction(SLIMCE)was used in Group B(40 eyes). All cases were implanted posterior chamber folding intraocular lens. We compared the best corrected visual acuity, corneal astigmatism, operation time, intraoperative complications, corneal edema, intraocular pressure and corneal endothelial cells in two groups of different postoperative time.

RESULTS: The postoperative best corrected visual acuity at 3 and 7d of Group A were better than those of Group B(P<0.05), and there was no difference in the 1d and 1mo after surgery(P>0.05). The corneal astigmatism of 1mo after surgery was much smaller in Group A, and there was a significant statistical difference between two groups(P<0.05). Less intraopretative complications happened in Group A, but there was not statistical difference between two groups(by Fisher's exact test, P=0.36). There was a significant statistical difference in corneal edema of these two groups at 1d after surgery(χ²=5.70, P<0.05). There were no significant differences in operation time, postoperative corneal edema, intraocular pressure and corneal endothelial cells in two groups at 7d(P>0.05).

CONCLUSION: Sclera tunnel incision phacoemulsification combined with manual nuclear extraction would be a preferred surgical technique for level V cataract.