Abstract: Objective To analyze the clinical charactaristics, operation complications and visual outcomes of the sugery for the cataract patients with hard nuclear lens in government organized cataract rehabilitation project. Design Retrospective case series. Participants Among 1061 cataract cases who accepted the surgery in government organized cataract rehabilitation project in Shanghai Aier eye hospital, 267 cases with hard nucleus (25.2%) were observed. The other 794 cases were considered as the control group. Method The clinical charactaristics, main intraoperative and postoperative complications and visual acuities were analyzed and compared with control group. Main Outcome Measures Clinical charactaristics, operation complications, visual acuity, and rehabilitation rate. Results Before the surgery, best corrected vision acuity (BCVA) of 124 cases (46.3%) were less than finger count; BCVA of 89 cases (33.3%) were less than or equal to 0.1; and BCVA of 54 cases (20.4%) were better than 0.1. Two cases were accompanied with lens dislocation, 6 cases were accepted filtration surgery before. Phacoemulsification were performed on 254 cases and extracapsular cataract extraction (ECCE) were performed on 13 cases. Posterior capsular ruptures were observed in 14 cases (5.24%) during the operations, the frequency of which was significantly higher than the control group (13 cases, 1.64%) (χ2=10.33, P<0.01). Cornea edema rate was 13.1% at the first day after operation, which was significantly higher than the control group (19 cases, 2.4%) (χ2=46.98, P<0.01). One month after the surgery, the BCVA of 261 cases (97.4%) were better than 0.05, BCVA of 234 cases (87.6%) were better than 0.3, and the BCVA of 72 cases (27.0%) were better than 0.6. Visual acuities after surgery were significantly better than before operation (χ2=367.51, P<0.01). Conclusion There is a high rate of hard nuclear cataracts in government organized cataract rehabilitation project. Fully estimating the complicated conditions, switching to ECCE in specific cases were wisdom strategies to deal with the possible intraoperative complications of hard nuclear cataracts and to acquire the best visual outcomes for those patients.

Key words: cataract extraction, blindness/prevention and control, hard nuclear