AIM: To determine the pattern of postoperative keratometric astigmatism in cataract operated adult patients in National Eye Centre, Kaduna. METHOD: This was a prospective randomised interventional study involving 150 patients with cataract distributed by random sampling into three groups for cataract surgery with posterior chamber intraocular lens (PCIOL) implantation. In group 1, 41 patients had extracapsular cataract extraction (ECCE), group 2, 68 patients had manual small incision cataract surgery (MSICS) by superior incision and group 3, 41 patients had manual small incision cataract surgery by temporal incision. The patients were evaluated with autokeratometer for keratometric astigmatism preoperatively, at 1 week and 6 weeks after surgery. Data was analyzed using SPSS Version 15 and p value less than or equal to 0.05 was considered statistically significant. RESULTS: The mean preoperative astigmatism for each of the groups was similar 0.67D, 0.727D and 0.72D (p=0.79). The mean surgically induced astigmatism (SIA) at one week was greater in extracapsular cataract extraction 2.86D than manual small incision cataract surgery by superior incision and least in manual small incision cataract surgery by temporal incision (Mtem) 0.97D (p=0.000). This significant difference in surgically induced astigmatism (SIA) suggested that the surgically induced astigmatism was dependent on the type of procedure used. There was a shift in the type of astigmatism from Against-the-rule (ATR) to With-the-rule astigmatism (WTR) in 29(70.73%) extracapsular cataract surgery and 21(51.2%) manual small incision cataract surgery by temporal incision. Increased Against-the-rule (ATR) in 41(60.3%) manual small incision cataract surgery by superior incision (Msup) was found in the first week after surgery. The surgically induced astigmatism was more stable 29(70.7%) in manual small incision surgery by temporal incision, than by superior incision 39 (57.4%) and extracapsular cataract extraction 10 (25.6%). This stability was not dependent on the patient’s age. CONCLUSION: Manual small incision cataract surgery by the two procedures induced less astigmatism and stabilized early. It is recommended that ophthalmic units in Nigeria be encouraged to convert to manual small incision cataract surgery by temporal incision.