Objective To review the complications of initial phacoemulsification in a grass-roots hospital and to investigate preventive measures from complications. Design Retrospective cases series. Participants 184 cataract patients of initial phacoemulsification in the Fangshan First Hospital. Methods 184 patients (188 eyes) were performed phacoemulsification and intraocular lens (IOL) implantation. The complications were observed and recorded. All patients were followed up 3-6 months. Main Outcome Measures The rate of main complications. Results Major complications during and after phacoemulsification cataract surgery included posterior capsule rupture in 8 eyes (4.3%), iris injury in 2 eyes (1.1%), corneal edema in 23 eyes (12.2%), uveitis in 16 eyes (8.5%), ocular hypertension in 4 eyes (2.1%), detachment of retina in 2 eyes (1.1%), after-cataract in 21 eyes (11.2%). At the last visit, the post-surgery visiual acuities were 0.5 or better in 149 eyes (79.3%). Conclusion There may be more complications happened in the initial phacoemulsification in a grass-roots hospital. It should be gradually developed under the direction of skilled surgeons.