When I was a resident ophthalmologist, we learned to do manual ECCE cataract surgery before moving to phacoemulsification. This manual Extra-Capsular Cataract Extraction technique involves making a large incision and extracting the nucleus whole, in a similar manner to MSICS. However there is one critical difference and that is the incision. In traditional manual ECCE, the crescent blade is used to start the incision but then it is enlarged with scissors, either Wescott scissors or corneo-scleral scissors. This results in an incision that is not as well-constructed as a MSICS procedure and as a result it requires multiple sutures for closure. You should certainly know what manual ECCE surgery entails, and I’m thankful for our guest surgeon for sending this video, but I encourage you to instead perform MSICS.