Background: Age-related cataract is the leading cause of blindness in the globe, accounting for 51% of all blindness. Most cataract cases occur in underdeveloped countries. MSICS (manual small incision cataract surgery) is a new procedure. As a common approach that combines all the benefits of phacoemulsification with the extra benefit of greater application, Objectives: To compare visual outcome and postoperative complications after MSICS and Phacoemulsification. Patients and methods: 100 eyes of 100 patients with senile cataract divided randomly into two groups. Group A 50 eyes underwent phacoemulsification, Group B: 50 eyes underwent Manual small incision cataract surgery (MSICS). Results: Regarding to visual outcome, at 3 months, 44 patients88% of phacoemulsification group had a best corrected distant visual acuity (BCDVA) of 6/12 or better as compared to 38 patients 78% in MSICS.In day one postoperative 96% of phacoemulsification group eyes exhibited moderate to severe corneal edema while only 14% of MSICS group exhibited moderate corneal edema, 2% sever edema the difference was statistically significant (p < 0.001). Best corrected visual acuity after 3 months post operative was comparable between two groups however surgically induced astigmatism (SIA) after three months was statistically significant (p < 0.001) with less SIA in phacoemulsification group compared to MSICS group with SIA. The incidence of Descemet's membrane detachment was also studied with no statistical significance between two groups with slightly higher rates in phacoemulsification group confined to incision site. Conclusion: Both phacoemulsification and MSICS are effective techniques in treating senile cataracts with satisfactory visual outcome. While MSICS have slight edge in terms of cost and fewer complications rate, uneventful phacoemulsification yields faster visual rehabilitation with better refractive outcomes which is more convenient in nowadays patients.