Objectives To systematic review the safety of routine preoperative testings versus selectivepreoperative testings for cataract surgery. Methods We searched the Cochrane Central Register of Controlled Trials-Central (which contains the Cochrane Eyes and Vision Group Trials Register) in the Cochrane Library (Issue 3, 2008), MEDLINE (1966 to Oct. 2008), EMBASE (1980 to Oct. 2008), CMB-disk (1979 to Oct. 2008). We also hand-searched related journals. All the search was restricted in English and Chinese. Methodological quality of randomized controlled trials (RCTs) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan 5.0 software was used for data management and analysis. Obtained evidence the safety of routine preoperative testings versus selective preoperative testings.Result Four RCTs involving 20 490 participants required cataract surgery were included by total retrieve and riddling. The result of metaanalysis showed that there was no significant difference between the two groups in the rates of intraoperative systemic events [RR=1.05, 95%CI (0.89, 1.24), P=0.59], postoperative systemic events [RR=0.97, 95%CI (0.80, 1.18), P=0.77], intraoperative ocular events [RR=0.99, 95%CI (0.74, 1.33), P=0.97] and postoperative ocular events [RR=1.11, 95%CI (0.76, 1.60), P=0.59]. Conclusion To compare routine preoperative testings group with selective preoperative testings group, there was no significant difference in the rates of intraoperative systemic events, postoperative systemic events, intraoperative ocular events and postoperative ocular events. However the application of the results to the patients with incapacitating systemic diseases needs further study.