Purpose: To assess the safety and efficacy of Manual Small Incision Cataract Surgery (MSICS) in cases of mature and hypermature cataracts .

Materials and Methods: Prospective observational study on 100  eyes of  patients with mature and hypermature  cataract who had undergone MSICS .The nucleus was prolapsed into anterior chamber by using a sinskey hook and extracted out of the eye using irrigating vectis. Intraoperative and postoperative findings as well as postoperative visual outcomes were used as main measures to report the safety and efficacy of the surgery.

Results: Of the 100 eyes, 64 had mature and 36  had hypermature cataract. Intraoperatively Continuous Curvilinear Capsulorrhexis(ccc) was incomplete in 3 eyes (3%) and had to be converted to canopener capsulotomy. None of the eyes had posterior capsular rupture or zonular dialysis and no eyes were converted to conventional Extra Capsular Cataract Extraction (ECCE). Postoperatively, 2 eyes (2%) developed corneal oedema with >10 Descemets folds and 1 eyes (1%) had corneal oedema with < 10 Descemets folds. Mild iritis was seen in 4 eyes (4%) and moderate iritis with fibrin membrane was seen in 2 eyes (2%). 97 patients (97%) had a best–corrected visual acuity of 6/9 or better on the 40th post–operative day.

Conclusion: In developing countries like India where phacoemulsification may not be affordable to a majority of those requiring cataract surgery, MSICS proves to be a safe and efficacious alternative for mature and hypermature cataracts