Purpose <p>To test the applicability of a mixed reality headset in cataract surgery.</p> Methods <p>Patients scheduled for phacoemulsification and intraocular lens implantation surgery were enrolled in our prospective interventional study. All patients underwent complete baseline ophthalmological examination and multimodal imaging analysis before surgery, which was scheduled and performed with the aid of the mixed reality headset. Primary outcomes were: surgical safety, efficacy and intraoperative parameters (Time lag, and surgical time duration). Secondary outcome was the occurrence of self-reported surgeon strain (SRSS), measured in a range from 0 to 5 and ergonomics, measured through the rapid upper limb assessment scale, RULA.</p> Results <p>A total of 100 phacoemulsification surgeries were performed. Surgical success was recorded in all cases (100%) and no intraoperative complications were documented (0%). Mean time lag was 50 ms and the mean intraoperative surgery duration was 14 ± 6 min. The SRSS was graded as 0 in all cases with the absence of neck and back pain nor nausea or visual disturbance.</p> Conclusions <p>The application of mixed reality in phacoemulsification surgery is an innovative, safe and effective tool in intraocular surgery.</p>