Purpose: To evaluate the hard nuclear cataract surgery outcomes by comparing the combined burst mode and continuous torsional mode conducted of Centurion Vision System.Methods: Prospective comparative cohort study.Based on the Emery-Little classification, this study assigned cataract patients with nuclear density grade III to V into two groups: the combined mode group (Group A) and the torsional mode group (Group B).Endothelial cell density (ECD), central corneal thickness (CCT), and best-corrected distance visual acuity (BCVA) were evaluated at different time intervals, including 1 day, 1 week, 1 month, and 3 months.Results: 207 patients: 100 in the group A and 107 in the group B. Patients in group A with severe nuclei experienced lower cumulative dissipated energy (p = 0.007) and shorter ultrasound time (p < 0.001).Both groups exhibited a decrease in ECD after surgery, but the decrease was comparatively lower among group A patients with severe nuclei (p < 0.05).There was a notable increase in the CCT in both groups at the 1-day and 1-week time points compared to the baseline values (p < 0.001).Changes in CCT were significantly greater in group B at 1-day (p < 0.001), 1-week (p = 0.002), and 1-month (p = 0.004) intervals among patients with severe nuclei.Conclusion: Burst torsional combined with longitudinal ultrasound can be more effective for harder nuclei phacoemulsification than the continuous torsional ultrasound.Trial Registration: This study was conducted in accordance with
Ainiwaer et al. (Sun,) studied this question.