To compare the outcomes of bimanual microphacoemulsification and coaxial miniphacoemulsification and assess the potential advantages of the former over the latter. Institute of Ophthalmology, University of Modena, Modena, Italy. In a controlled prospective clinical trial, 100 eyes of 50 patients with nuclear or corticonuclear cataract of grade 2 to 4 on the Lens Opacities Classification System III had phacoemulsification. Fifty eyes were randomized to have surgery by the bimanual technique and 50, by the coaxial technique. All surgeries were performed by the same surgeon using the same machine (Sovereign WhiteStar, American Medical Optics). In all cases, the incision was made superiorly in clear cornea and a hydrophobic acrylic flexible intraocular lens (Acri. Smart 48 S, Acri.Tec) was implanted. Intraoperative parameters were mean phacoemulsification time, total phacoemulsification percentage, effective phacoemulsification time (EPT), total volume of balanced salt solution (BSS) used, total surgical time, and final size of the corneal incision. Postoperative parameters were visual acuity, astigmatism changes by vector analysis, corneal thickness, endothelial cell count, and presence of flare and cells in the anterior chamber. The only statistically significant difference between the 2 groups was the total volume of the BSS used (P = .004) and total surgical time (P = .045). Both techniques were safe and effective for cataract surgery. With bimanual microphacoemulsification, significantly less BSS was used and the total surgical time was significantly shorter than with the coaxial method.