Manual small incision cataract surgery (MSICS) has widely been used in clinical operation, especially in developing countries. This article aims to compare the efficacy and safety (intraoperative and postoperative complications) among conventional extracapsular cataract extraction (ECCE), MSICS and phacoemulsification. By using the PubMed search engine, we collected the relevant literatures on MSICS, ECCE and phacoemulsification. Meanwhile, the relevant literatures published in Chinese journals were also referred to. Compared with phacoemulsification, both MSICS and ECCE achieved excellent visual outcomes with low complications. MSICS does not depend on expensive instrument, and is significantly faster, less expensive, and requires less technology; therefore, MSICS is especially suitable to hard nucleus cataract surgery. Though MSICS demands skill and patience during cataract surgery, it is a safe, effective and economical treatment and is used as an alternative to phacoemulsification in developing countries.