Objective To investigate the effect and safety of phacoemulsification and intraocular lens implantation in advanced and middle aged senile patients. Methods Ninety five patients (80 96 years old, 100 eyes) with senile cataract were included in advanced aged group. Another 665 patients (60 79 years old, 671 eyes) with senile cataract were included in middle aged group. All patients were performed with phacoemulsification and intraocular lens implantation through a corneal limbus tunnel incision. Results Visual acuity for the advanced aged group at 1 day, one week and one month after operation was 0 5 or better in 30 eyes, 52 eyes and 74 eyes, respectively. Both groups were followed up from 3 to 36 months after operation. The visual acuity of 0 5 or better were followed up in 82 eyes (82 0%) in the advanced aged group and in 583 eyes (86 9%) in the middle aged group. The postoperative complications included tears of posterior capsule, detached vitreous, subluxation of lens, corneal edema, and muddy posterior capsule. Conclusions Phacoemulsification and intraocular lens implantation is effective and safety for both advanced and middle aged patients with senile cataract.