目的：比较不同的劈核方式对硬核白内障患者中央角膜厚度、角膜内皮细胞(CEC)数量、泪液炎性指标的影响。方法：回顾性研究。纳入2020年1月至2022年12月我院收治的硬核白内障患者89例89眼，根据术中劈核方式不同分为反式预劈核组46眼和超乳劈核组43眼。比较两组患者手术总有效率及视力恢复情况； 观察两组患者手术前后角膜相关指标(中央角膜厚度、CEC数量、CEC面积)、泪液炎性指标、泪膜功能[泪膜破裂时间(BUT)、中国干眼问卷量表(CDEQ)、泪液分泌试验( SⅠt)]，并评价角膜水肿程度。结果：超乳劈核组有效超声时间、超声能量及累积复合能量参数均大于反式预劈核组(P<0.05)。反式预劈核组术后7 d，1 mo的黄斑区视网膜厚度小于超乳劈核组，术后3、7 d的中央角膜厚度小于超乳劈核组，术后3 mo CEC计数多于超乳劈核组，CEC丢失率低于超乳劈核组，术后3 mo CEC面积小于超乳劈核组(P<0.05)。反式预劈核组术后7 d，1 mo的泪液TNF-α、IL-6水平均低于超乳劈核组(P<0.05)。反式预劈核组术后1、3 mo的BUT均长于超乳劈核组(P<0.05)。反式预劈核组术后1、3 mo CDEQ评分均低于超乳劈核组(P<0.05)。反式预劈核组术后1、3 mo的SⅠt均高于超乳劈核组(P<0.05)。反式预劈核组术后1 d的角膜水肿程度低于超乳劈核组(P<0.05)。结论：相比于超声乳化劈核，应用反式劈核钩预劈核联合超声乳化白内障摘出术治疗硬核白内障，能减小超声能量，更利于降低术后炎性程度，改善泪膜功能，减轻角膜水肿程度。

AIM: To compare the effects of different nucleus chopping methods on the central corneal thickness, corneal endothelial cell(CEC)count and tear inflammatory indicators in patients with hard nucleus cataract.METHODS: Retrospective study. Totally 89 patients(89 eyes)with hard nucleus cataract who treated in our hospital were included from January 2020 to December 2022. According to different intraoperative nucleus chopping methods, the patients were divided into reverse prechop group(46 eyes)and phaco-chop group(43 eyes). The total effective rate of surgery and visual acuity recovery were compared between the two groups. Corneal related indicators(central corneal thickness, CEC count, CEC area), tear inflammatory indicators and tear film function [tear film break-up time(BUT), Chinese Dry Eye Questionnaire(CDEQ), Schirmer Ⅰ test(SⅠt)] were observed before and after surgery in both groups, and the degree of corneal edema was evaluated.RESULTS: The effective phaco time, phaco energy and cumulative complex energy parameters in the phaco-chop group were longer or higher than those in the reverse prechop group(P<0.05). The macular retinal thickness in the reverse prechop group at 7 d and 1 mo after surgery was thinner than that in the phaco-chop group, the central corneal thickness at 3 and 7 d after surgery was also thinner than that in the phaco-chop group, the CEC count at 3 mo after surgery was more than that in the phaco-chop group, the CEC loss rate was lower than that in the phaco-chop group, and the CEC area at 3 mo after surgery was smaller than that in the phaco-chop group(P<0.05). The levels of tear TNF-α and IL-6 at 7 d and 1 mo after surgery in the reverse prechop group were lower than those in the phaco-chop group(P<0.05). The BUT at 1 and 3 mo after surgery was longer in the reverse prechop group than that in the phaco-chop group(P<0.05). The CDEQ score in the reverse prechop group was lower than that in the phaco-chop group at 1 and 3 mo after surgery(P<0.05). The SⅠt at 1 and 3 mo after surgery was higher in the reverse prechop group compared with that in the phaco-chop group(P<0.05). The degree of corneal edema at 1 d after surgery was milder in the reverse prechop group than that in the phaco-chop group(P<0.05). CONCLUSION: Compared with phaco-chop, the application of reverse-chopper prechop combined with phacoemulsification can better reduce the ultrasonic energy in the treatment of hard nuclear cataract, and it is more conducive to reducing the postoperative inflammatory degree, improving the tear film function and relieving the corneal edema degree.