Objective: To study the outcome ofphacoemulsification (PE) compared to standardextracapsular surgery before the introduction ofstate-of-the-art techniques (capsulorhexis,hydrodissection, nuclear cracking, nuclear chopping,sutureless incisions) and sophisticated equipment. Study design: Charts from 375 patients (453 eyes)undergoing PE between 1984 and 1989 were randomlyselected and studied retrospectively. A minimum ageof 35 years, and a minimum follow-up of three monthswere required.Setting: A large eye hospital in the Kingdom of SaudiArabia staffed with an international faculty ofophthalmic surgeons.Patients: Patients over 35 years of age undergoing PE for immature, mature and traumatic cataract.Main outcome measures: Postoperative visual acuity,and rate or frequency of intraoperativecomplications. Results:66.5% achieved visual acuity of 20/40 orbetter, which compares favourably with the 36.5% ofeyes reaching this level of visual acuity after mainlystandard extracapsular cataract surgery in anotherstudy at our hospital. Posterior capsule rupturesoccurred in 7.5% and vitreous loss in 5.5%. Otherocular disease (odds ratio 7.51 confidence interval4.43-12.7) and intraoperative complications (oddsratio 2.97 confidence interval 1.38-6.42) werestatistically significant predictors for final visualacuity of under 20/40 (p = <0.001 and="" 0.005respectively).="" conclusion:="" the="" outcome="" of="" pe="" was="" better="" than="" that="" ofstandard="" extracapsular="" cataract="" extraction="" in="" the="" samesetting.="" however,="" since="" pe="" appeared="" to="" be="" usedselectively,="" no="" clear="" advantage="" compared="" toextracapsular="" cataract="" extraction="" is="" evident="" in="" theperiod="" before="" the="" introduction="" of="" modern="" state-of-the-art="">