Aim: To compare the endothelial cell loss between phacoemulsification and manual small–incision cataract surgery (SICS). Endothelial cell loss was also compared in phacoemulsification group by temporal clear corneal incision (CCI) and by superior scleral incision (SI) technique. Materials and Methods: A total of 200 eyes of 200 patients were included in the study. Cases were randomly divided into two equal groups. Group A had undergone phacoemulsification and Group B had under gone manual SICS. In Group A 50 cases were performed by temporal CCI and remaining 50 cases were performed by superior SI technique. Endothelial cell count was evaluated by using a noncontact specular microscope. Results: Mean endothelial cell loss (cells/mm2) in Group A was 307.80 (12.33%), 397.79 (15.93%), and 421.69 (16.89%) on 1 week, 6 week, and 3 month postoperative period, respectively. In Group B, it was 270.86 (10.63%), 385.22 (15.12%), and 413.68 (16.24%) on 1 week, 6 week, and 3 month postoperative period, respectively. There was no clinical and statistically significant difference (P > 0.05) between the two groups. The mean endothelial cell loss in Group A by CCI was 340.68 (13.61%), 427.80 (17.08%), and 448.70 (17.92%) and by SI was 274.92 (11.05%), 367.78 (14.78%), and 394.68 (15.83%) on 1 week, 6 week, and 3 month postoperative period respectively. There was statistically significant difference in endothelial cell loss at 1 week (P < 0.05) but it was not statistically significant on 6 week and 3 month postoperatively (P > 0.05). Conclusion: There was no clinically or statistically significant difference in endothelial cell loss or visual acuity between phacoemulsification and manual SICS at 3 month postoperative period.