Phacoemulsification and aspiration were performed with a sleeveless ultrasound tip through an ultrasmall incision (1.2 to 1.4 mm) using a 20-gauge irrigating hook through a side port to infuse the anterior chamber. After the lens was extracted, the incision was enlarged to 2.2 mm and a single-piece intraocular lens (AcrySof SA30AL, Alcon) with an optic diameter of 5.5 mm was inserted. By modifying the new injector system, the AcrySof SA30AL could be inserted through a 2.2 mm incision in 100% of cases (63 eyes) in which it was feasible to use a thin lens having a central thickness of less than 20 diopters (D). A 2.2 mm incision was also used successfully in 54% of cases (42 of 78 eyes) that required a lens with a central thickness of 20 D or higher.