Introduction: Phacoemulsification and manual small incision cataract surgery (MSICS) are sutureless surgeries with low complication rates and satisfactory visual outcomes. Compared to phacoemulsification, MSICS, a cost effective surgical technique, could better suit high volume surgery scenario of resource-poor settings. Objective was to compare preoperative macular thickness of patients undergoing uncomplicated phacoemulsification and MSICS and again postoperatively on days 1, 7 and 40 using optical coherence tomography (OCT). Material and Methods: Randomized study at Rotary Eye Hospital, Malegaon. Patients of age 35-85years having undergone uneventful phacoemulsification or MSICS were included. Patients with co-existing ocular pathologies were excluded. Examination included indirect ophthalmoscopy, slit lamp biomicroscopy with 90 D lens and macular thickness measurements preoperatively and on days 1, 7 and 40postoperatively using OCT. Results: Mean macular thickness in MSICS group was 187.71+/-17.22 μm preoperatively and 201.91+/-18.95μm, 208.04+/-18.66μm, 215.25+/-19.38 μm, postoperatively on days 1, 7 and 40 respectively. Mean macular thickness in phacoemulsification group was 185.77+/-15.64 μm preoperatively and 195.77+/-17.38 μm, 199.05+/-16.87 μm, 203.76 +/-17.48 μm postoperatively on days 1, 7and 40 respectively. Postoperative macular thickness (days 1, 7 and 40) was significantly higher in the MSICS group (p= 0.013, p<0.000 and p<0.000 respectively). There was neither clinical, nor OCT evidence of cystoid macular edema in either group. Conclusion: The subclinical increase in macular thickness was higher following MSICS. However, final visual outcome remained unaffected. For resource-poor settings, MSICS still serves as a good means of offering comparable visual outcomes.