目的：探讨小切口非超声乳化水平空间劈核术与超声乳化分别联合区域折射型多焦点人工晶状体(MIOL)植入治疗硬核白内障的疗效。方法：回顾性分析2022年1月至2023年12月我院收治的硬核白内障患者288例288眼，根据治疗方式不同分为对照组144眼(采用超声乳化+区域折射型MIOL进行治疗)、观察组144眼(采用小切口非超声乳化水平空间劈核术+区域折射型MIOL进行治疗)。比较两组患者手术时间，手术前后最佳矫正视力、散光、中央角膜厚度、角膜内皮细胞密度、泪膜功能、并发症。结果：两组患者手术时间比较无差异(P>0.05)。术前和术后3 mo两组患者最佳矫正视力比较均无差异(均P>0.05)，两组患者术后3 mo最佳矫正视力均较术前改善(均P<0.05)。术后1 wk，3 mo两组间中央角膜厚度、角膜内皮细胞密度、散光比较均有差异(均P<0.05)。术后1 wk两组间BUT和OSDI评分比较均有差异(均P<0.001)，观察组患者并发症发生率(4.2%)明显低于对照组(18.1%)(P<0.001)。结论：两种手术方式均能有效治疗硬核白内障患者，小切口非超声乳化水平空间劈核术联合区域折射型MIOL植入对角膜损伤更轻，并发症更少。

AIM: To investigate the efficacy of small-incision horizontal space nuclear splitting surgery and phacoemulsification combined with regional refractive multifocal intraocular lens(MIOL)implantation in the treatment of hard nuclear cataract.METHODS:A retrospective analysis was performed for 288 patients(288 eyes)with hard nuclear cataract who admitted to our hospital from January 2022 to December 2023, and they were divided into control group(144 eyes treated with phacoemulsification and regional refractive MIOL)and observation group(144 eyes treated with small-incision horizontal space nuclear splitting surgery and regional refractive MIOL)according to different treatment methods. The operation time, pre- and post-operative best corrected visual acuity, astigmatism, central corneal thickness, corneal endothelial density, tear film function, and complications were compared between the two groups.RESULTS:There was no difference in operation time between the two groups(P>0.05). There was no difference in the preoperative and 3 mo postoperative best corrected visual acuity(all P>0.05), and the best corrected visual acuity of the two groups at 3 mo postoperatively was improved compared with the preoperative level(all P<0.05). There were differences in central corneal thickness, corneal endothelial density and astigmatism between the two groups at 1 wk and 3 mo after surgery(all P<0.05). There were differences in breakup time(BUT)and ocular surface disease index(OSDI)scores between the two groups at 1 wk after surgery(all P<0.001), and the incidence of complications in the observation group(4.2%)was significantly lower than that in the control group(18.1%; P<0.001).CONCLUSION:Both surgical methods can effectively treat patients with hard nuclear cataracts, and small-incision horizontal space nuclear splitting surgery combined with regional refractive MIOL implantation has less corneal damage and fewer complications.