Microincision cataract surgery (MICS) represents a new level in the development of cataract surgery. Phacoemulsification with intraocular lens (IOL) implantation via incisions of <or=2 mm may be performed by the coaxial approach, such as conventional phacoemulsification but with a smaller diameter of the phaco tip (C-MICS), or by the biaxial approach, with separation of the phaco tip and irrigation (B-MICS). Compared with standard small-incision cataract surgery, the advantages of MICS are less corneal astigmatism and fewer corneal surface irregularities, with favorable implications for visual quality and early rehabilitation. In the effort toward smaller incisions, special interest should be given to wound integrity, especially regarding the risk of endophthalmitis. With limited corneal elastic capacity, irreversible expansion of the incision with tissue laceration may occur. Smaller incisions are superior only if they cause less trauma. This requires an optimized relationship between incision size and manipulation during IOL implantation as well as attention to safety issues. MICS offers a platform for new benchmarks in phacoemulsification.