Aim: To compare the optical outcomes of biaxial microincision cataract surgery (B-MICS) versus coaxial small-incision cataract surgery (C-SICS).Methods: Thirty patients (sixty eyes) with bilateral age-related cataract underwent B-MICS through a 1.7 mm clear corneal incision (CCI) in one eye and C-SICS through a 2.8-mm CCI in the other eye. Every eye was implanted with a micro-incision aspheric aberration-free intraocular lens (Akreos MI60 AO). Preoperative corneal aberrations, and 3-month postoperative corneal and total ocular aberrations were calculated and compared.Results: The 3-month postoperative corneal root mean square (RMS) of third- to sixth-order aberrations (p<0.001), third-order trefoil (p = 0.001), trefoil-like (p<0.001), and third-order RMS (p<0.001) were lower in the B-MICS group than in the C-SICS group. Surgically induced corneal trefoil was reduced in B-MICS eyes (p = 0.001). The total ocular high-order RMS (p = 0.002), third-trefoil (p<0.001), trefoil-like (p<0.001) and fifth-order RMS (p<0.001) were lower in B-MICS than in C-SICS eyes. Corneal aberrations were positively correlated with ocular aberrations for the RMS of third- to sixth-order aberrations, third-trefoil and spherical-like aberrations. Visual acuity, refraction and corneal astigmatism were not different between both groups.Conclusion: Compared with conventional surgery, B-MICS could improve the optical performances of the pseudophakic eye reducing surgically induced corneal higher-order aberrations.