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To study the viability of 'manual small incision cataract surgery' for effective rehabilitation of cataract patients in community eye care settings. A randomised controlled clinical trial; to compare manual small incision cataract surgery (MSICS) with conventional extracapsular cataract surgery (ECCE- PCIOL) with respect to safety, cost-effectiveness, surgical time and patient satisfaction and visual function. In a masked randomised controlled clinical trial, 741 patients with operable cataract were randomly assigned to receive one of the two treatment groups. 706 of the 741 patients were followed up till six weeks. 135 of 362 (37.3%) of ECCE group and 165 of 344 (47.9%) of MSICS group had uncorrected visual acuity of 6/18 and better after six weeks of follow- up, which was statistically significant. 314 of 362 (86.7%) of ECCE group and 309 of 344 (89.8%) of MSICS group had corrected postoperative vision of 6/18 or better. There was no significant difference between the two groups for intraoperative and severe postoperative complications. Both techniques took similar surgical time.