Background: To investigate early change of ceal aberrations after 2.8-mm superior incision phacoemulsification. Methods: This study comprised 80 eyes of 75 patients. All the patients underwent phacoemulsification with monofocal foldable intraocular lens (IOLs) implanted through a 2.8-mm superior ceal incision. The anterior ceal wavefront aberrations for the 6.0-mm pupillary diameter was measured by iTrace wavefront aberrometer (Tracey Technologies, Inc.) preoperatively and 1 month postoperatively. Changes of root mean square (RMS) values of Z(3, ?3), Z(3, 3), Z(3, ?1), Z(3, 1), and Z(4, 0) and total high order aberration (HOA) were evaluated. Results: The uncorrected and corrected visual acuities improve significantly (P<0.001). No significant postoperative changes were observed in spherical aberration (P=0.652). Significant changes in vertical coma and vertical trefoil (0.005±0.214 vs. ?0.049±0.242, P=0.037; ?0.141±0.222 vs. ?0.258±0.359, P=0.001;separately). However, the total HOAs increased after cataract surgery (0.567±0.161 vs. 0.688±0.343, P<0.001). Conclusions: Ceal vertical coma and vertical trefoil changes significantly in 2.8mm superior ceal incision phacoemulsification cataract surgery. In addition, those had a trend to negative direction.