Purpose To evaluate the postoperative astigmatism and complications after manual multi-phacofragmentation (MPF) cataract surgery through a 3.2 mm clear corneal incision (CCI). Setting Department of Ophthalmology, Hospital General de Segovia, Segovia, Spain. Methods In a retrospective study, 50 eyes of 50 patients had cataract surgery by MPF. Patients were divided into 3 groups according to type of cataract. This technique uses a racquet-shaped nucleotome, a spatula, and 2 manipulators, right and left, for nuclear fragments. With these instruments, the nucleus is fragmented into multiple small pieces that are extracted from the anterior chamber. Astigmatism was evaluated before surgery and 7 days and 1 and 3 months after surgery by Gaussian distribution ( P < .05). Intraoperative and postoperative complications were recorded. Results Mean postoperative astigmatism was 0.77 diopters (D) ± 0.29 (SD) at 7 days, 0.47 ± 0.22 D at 1 month, and 0.21 ± 0.22 D at 3 months. During surgery, 2 cases (4%) of slight transient intracameral bleeding in the anterior chamber occurred. After surgery, 5 eyes (10%) had corneal edema, 2 (4%) had iritis, and 3 (6%) had ocular hypertension. Conclusions Using MPF, soft and hard nuclei can be removed through a 3.2 mm CCI. The astigmatic results were favorable and the complications few.