Purpose: To compare the effect on the corneal endothelium of femtosecond laser–assisted cataract surgery and conventional phacoemulsification cataract surgery.

Setting: Private clinic, Tasmania, Australia.

Design: Prospective comparative cohort study.

Methods: Femtosecond laser–assisted cataract surgery (study group) or conventional phacoemulsification (control group) was performed. The central corneal thickness, central 3.0 mm corneal volume, volume stress index, and central endothelial cell density (ECD) were measured preoperatively and 1 day, 3 weeks, and 6 months postoperatively.

Results: The study group comprised 405 eyes and the control group, 215 eyes. Postoperative corneal edema was significantly less in the study group at 1 day and 3 weeks. However, the difference was negligible at 6 months. The study group had significant reductions in the ECD compared with the control group at 3 weeks but not at 6 months (6-month mean −150 cells/mm² ± 244 [SD] versus −149 cells/mm² ± 233). Eyes in the study group with laser-automated corneal incisions had greater endothelial cell loss at 6 months than eyes in the study group with manual corneal incisions and eyes in the control group (P < .0001). Eyes in the study group with zero effective phaco time and manually created corneal incisions had statistically significantly less endothelial cell loss at 6 months than the other groups (P < .0001).

Conclusions: Femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification; however, the difference diminished with time. Laser-automated corneal incisions seemed to adversely affect the corneal endothelial cells.