of the remaining lens cortex (outer layer of lens) material from the capsular bag, and capsular polishing (the removal of all remaining epithelial cells from the capsule), if needed; Implantation of the folded intraocular replacement lens, usually into the remaining posterior capsule, and ensuring that it unfolds correctly. Aligning the IOL in the correct axis to counteract astigmatism if a toric IOL; Removal of ophthalmic viscosurgical devices; The viscoelastic that was injected to stabilize the anterior chamber, protect the cornea from damage, and distend the cataract's capsule during IOL implantation must be removed from the eye to prevent post-operative viscoelastic glaucoma (a severe intra-ocular pressure increase). This is done via suction from the irrigation-aspiration instrument and replacement by buffered saline solution (BSS). Removal of OVD from behind the implant reduces the risk and magnitude of postoperative pressure spikes or capsular distention; Wound sealing and hydration. The incision is sealed by elevating the pressure inside the globe with BSS which presses the internal tissue against the external tissue of the incision, holding the incision closed. If this does not achieve a satisfactory seal a suture may be added. Manual small incision cataract surgery The pupil is dilated using drops (if the IOL is to be placed behind the iris) to help better visualise the cataract. Pupil-constricting drops are reserved for secondary implantation of the IOL in front of the iris (if the cataract has already been removed without primary IOL implantation). Anesthesia may be placed topically as eyedrops or via injection next to (peribulbar) or behind (retrobulbar) the eye. Topical anaesthetics are commonly used at the same time as a intracameral lidocaine injection to reduce pain during the operation. Oral or intravenous sedation may also be used to reduce anxiety. General anesthesia is rarely necessary, but may be employed for children and adults with particular medical or psychiatric issues. The operation may occur on a stretcher or a reclining examination chair. The eyelids and surrounding skin will be swabbed with disinfectant. The face is covered with a cloth or sheet, with an opening for the operative eye. The eyelid is held open with a speculum to minimize blinking during surgery. Pain is usually minimal in properly anesthetised eyes, though a pressure sensation and discomfort from the bright operating microscope light is common. The ocular surface is kept moist during the procedure using sterile saline eye drops or methylcellulose viscoelastic. The small