Comparing Surgical Techniques: Outcomes of Phacoemulsification Versus Manual Small Incision Cataract Surgery (MSICS)

Background: Cataract remains the leading cause of reversible blindness worldwide, particularly in developing countries. Two widely practiced surgical techniques for cataract extraction are phacoemulsification and manual small incision cataract surgery (MSICS). While phacoemulsification is considered the gold standard in developed settings due to faster recovery and minimal incision size, MSICS remains highly relevant in resource-limited regions due to its cost-effectiveness and comparable outcomes. Aim: To compare the clinical outcomes, visual recovery, complications, and surgical efficiency of phacoemulsification and manual small incision cataract surgery. Methods: A prospective comparative observational study was conducted at Government Medical College & Hospital, Bettiah, West Champaran, Bihar, India, between 5th March 2025 to 28th February 2026. A total of 150 patients diagnosed with age-related cataract were included. Patients were divided into two groups: Phacoemulsification group (n=75) and MSICS group (n=75). Postoperative outcomes including visual acuity improvement, intraoperative and postoperative complications, and recovery time were evaluated. Results: Both techniques significantly improved postoperative visual acuity. Phacoemulsification demonstrated slightly faster visual recovery and lower surgically induced astigmatism. However, MSICS showed comparable final visual outcomes and shorter operative time with lower cost. Conclusion: Both phacoemulsification and MSICS are safe and effective techniques for cataract surgery. While phacoemulsification offers faster recovery and lower astigmatism, MSICS remains an excellent alternative in high-volume and resource-limited settings.