目的：探讨手法小切口白内障手术(MSICS)两种切口制作方法对高龄硬核白内障术中操作和术后效果的影响，评价两种切口制作方法的优劣。

方法：回顾性分析我院2017-02/2019-02收治的硬核年龄相关性白内障患者56例56眼，按手术方式的不同分为两组：A组(31眼)长切口(约7～8mm)、长隧道(中央5mm区长3.5～4mm，两侧内切口向侧后外方延伸约1～1.5mm，使切口后层前端呈梯形)、厚巩膜瓣(约2/3巩膜厚)； B组(25眼)短切口(约5.5mm)、短隧道(长3mm，内切口规整齐平，呈线性)、常规厚度巩膜瓣(约1/2巩膜厚)。比较术后第1d，1wk，1、3mo最佳矫正视力恢复情况； 术后第1d，1wk中央角膜厚度； 术后3mo角膜散光度数、角膜内皮细胞损失程度等指标。

结果：两组术后1d，1wk，1、3mo的最佳矫正视力≥0.5的术眼：A组77%、90%、94%、94%； B组：32%、72%、88%和88%\〖β=-1.338，Exp(β)=0.262，P<0.05\〗。两组患者手术前后中央角膜厚度具有时间差异性和交互效应(P<0.05)，无组间差异性(P>0.05)。术后3mo两组角膜内皮细胞密度：A组2159.84±245.20个/mm²，B组2019.68±203.97个/mm²(t=2.289，P<0.05)。术后3mo两组角膜散光度数：A组1.57±0.74D，B组1.39±0.71D(t=0.930，P>0.05)。

结论：对高龄硬核白内障患者行长切口、长隧道、厚巩膜瓣、内切口为梯形的MSICS比短切口、短隧道、常规厚度巩膜瓣、内切口为线性的MSICS损伤更小，恢复更快，效果更理想。

METHODS: A retrospective analysis of 56 patients with senile cataract with hard nucleus from February 2017 to February 2019 in our hospital was made, which was divided into two groups according to the different surgical methods. group A(31 eyes)with long incision(about 7-8mm), long tunnel(central 5mm length 3.5-4mm, internal incision of both sides extending about 1-1.5mm to the back of the side, making the front end of the incision trapezoid), thick scleral flap(about 2/3 film thickness). group B(25 eyes)with short incision(about 5.5mm), short tunnel(long 3mm, regular flush of internal incision, linear), and regular thickness scleral flap(about 1/2 film thickness). The best corrected visual acuity recovery of 1d, 1wk, 1mo and 3mo after operation, central corneal thickness after 1d, 1wk operation and corneal astigmatism degree, corneal endothelial cell loss degree after 3mo operation were compared.

RESULTS: The best corrected visual acuity(greater than or equal to 0.5)for 1d, 1wk, 1mo and 3mo after operation in the two groups(77%, 90%,94% and 94% in the A group and 32%, 72%, 88% and 88% in the B group)was statistically significant \〖β=-1.338, Exp(β)=0.262, P<0.05\〗. The central corneal thickness of the two groups had time difference and interaction effect before and after operation(P<0.05), and there was no difference between the two groups(P>0.05). There was a statistically significant difference in corneal endothelial cell density(2159.84±245.20/mm² in the group A and 2019.68±203.97/mm² in the group B)between the two groups after 3mo of operation(t=2.289, P<0.05). There was no significant difference in corneal astigmatism between the two groups(group A 1.57±0.74D and group B 1.39±0.71D)after 3mo of operation(t=0.930,P>0.05).

CONCLUSION: MSICS with long incision, long tunnel, thick scleral flap and trapezoidal internal incision has less damage, quicker recovery and better effect on patients with hard nucleus aged cataract than short incision, short tunnel and linear internal incision.