Background: Manual small incision cataract surgery (MSICS) represents a cost-effective surgical technique particularly relevant for resource-limited settings. This study evaluated postoperative visual acuity outcomes and patient satisfaction following MSICS in adult cataract patients. Methods: A prospective observational study was conducted at a tertiary eye care hospital. A total of 312 patients aged 45-75 years with age-related cataract underwent MSICS with posterior chamber intraocular lens implantation. Visual acuity assessment was performed preoperatively and at 1 day, 1 week, 6 weeks, and 3 months postoperatively using Snellen's chart. Patient satisfaction was evaluated at 3 months using a validated questionnaire. Complications were documented systematically. Statistical analysis included paired t-tests, chi-square tests, and multiple regression analysis. Results: Mean age was 62.4 ± 8.7 years with 56.4% females. Preoperative mean best-corrected visual acuity (BCVA) improved from 1.24 ± 0.38 logMAR to 0.18 ± 0.24 logMAR at 3 months (p<0.001). At 3 months, 86.2% achieved BCVA ≥6/12, and 68.3% achieved ≥6/6. Good visual outcome (6/6-6/18) was attained in 91.7% of patients. Overall patient satisfaction was high, with 89.4% reporting being "satisfied" or "very satisfied." Mean satisfaction score was 8.4 ± 1.6 on a 10-point scale. Complications included posterior capsular rupture (2.2%), corneal edema (8.3%), and posterior capsular opacification requiring YAG laser (12.5% at 3 months). Predictors of better visual outcomes included younger age (p=0.012), absence of ocular comorbidities (p<0.001), and nuclear sclerosis grade ≤3 (p=0.008). Conclusion: MSICS demonstrates excellent visual outcomes and high patient satisfaction with acceptable safety profile, establishing its efficacy as a viable surgical option for cataract management, particularly in high-volume settings.

manual small incision cataract surgery, visual acuity, patient satisfaction, postoperative outcomes, intraocular lens, phacoemulsification alternative