than manual phacoemulsification. The laser is used to make the corneal incision, the capsulotomy and to initiate lens fragmentation, which reduces the energy requirements for phacoemulsification. It offers high precision, effective lens fragmentation at lower power levels and good optical quality, but as of 2022 has not been shown to have significant visual, refractive or safety benefit over manual phacoemulsification, and it has a higher cost. Extracapsular cataract extraction (ECCE), also known as manual extracapsular cataract extraction, is the removal of almost the entire natural lens in one piece, while the elastic lens capsule (posterior capsule) is left intact to allow implantation of an intraocular lens. It involves manual expression of the lens through a large (usually 10–12 mm) incision made in the cornea or sclera. Although it requires a larger incision and the use of stitches, this method may be indicated for patients with very hard cataracts or other situations in which phacoemulsification is problematic. The manual small incision cataract surgery (MSICS) technique is an evolution of ECCE where the entire lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing. The "small" in the title refers to the wound being relatively smaller than in ECCE, although it is still markedly larger than a phaco wound. Head-to-head trials of MSICS vs phaco in dense cataracts have found no difference in outcomes, but shorter operating time and significantly lower costs with MSICS. Intracapsular cataract extraction (ICCE) is the removal of the lens and the surrounding lens capsule in one piece. The procedure has a relatively high rate of complications due to the large incision required and pressure placed on the vitreous body. It has therefore been largely superseded and is rarely performed in countries where operating microscopes and high-technology equipment are readily available. After lens removal by ICCE, an intraocular lens implant can be placed in either the anterior chamber or sutured into the ciliary sulcus.Cryoextraction is a technique used in ICCE in which the cataract is extracted using a cryoprobe, the refrigerated tip of which adheres to the tissue of the lens at the contact point by freezing with a cryogenic substance such as liquid nitrogen, facilitating its removal. It is now used primarily for the removal of subluxated lenses. Refractive lens exchange is effectively the same procedure used to