Abstract: Objective To observe the efficacy and safety of extracapsular cataract extraction with double incision or single incision in the elderly patients with hard nucleus cataract and low corneal endothelial cell density. Methods From January 2017 to March 2020, 65 elderly patients (65 eyes) with hard nucleus cataract and low corneal endothelial cell density were enrolled in our hospital. They were divided into two groups according to surgical methods. Group A (33 patients, 33 eyes) underwent double incision extracapsular cataract surgery. Group B(32 patients, 32 eyes) underwent single incision extracapsular cataract surgery. The intraoperative maintenance of anterior chamber in both groups was observed. All the patients were followed up for 6 months, and the best corrected visual acuity (BCVA), the density of corneal endothelial cell, central corneal thickness (CCT) and the degree of corneal astigmatism were compared between the two groups. Results The anterior chamber of group A was more stable than that of group B at irrigating-aspirating (P<0.05). There was no difference in operation time between the two groups. One day after operation, there was significant difference in the proportion of patients with BCVA≥0.5 between the two groups (χ²=4.481, P=0.034), but there were no significant differences in visual acuity between the two groups 1 week, 1 month and 3 months after operation. Six months after operation, there were significant differences in the density of corneal endothelial cell and the rate of corneal endothelial cell loss between the two groups (P<0.05). The level of CCT of both groups 1 day after operation was significantly higher than that before operation (P<0.05), but there were no significant differences in CCT between the two groups at each observation point after operation. There were no significant differences in postoperative astigmatism degree and surgical-induced astigmatism degree between the two groups at each observation point. Conclusions Compared with single incision extracapsular cataract surgery, double incision extracapsular cataract surgery has less corneal injury and faster postoperative visual acuity recovery in the patients with hard nucleus cataract and low corneal endothelial density.

Key words: double incision, extracapsular, cataract surgery, hard nucleus, corneal endothelial cell