Background: Phacoemulsification has become the routine procedure for cataract extraction for most of the surgeons because of its smaller incision and rapid visual rehabilitation. Also, manual small incision cataract surgery (MSICS) with its sutureless relatively smaller incision, compared to conventional extracapsular cataract extraction, has similar advantages to phacoemulsification in addition to its lower risk to corneal endothelium especially in hard cataracts and elder patients. Objective: To compare the effect of phacoemulsification and small incision cataract surgery on corneal topography in a prospective randomized study. Patients and methods: 80 eyes were included in this study. Patients were divided into two groups: Group A (40 eyes) underwent phacoemulsification and Group B (40 eyes) underwent MSICS. Both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, and corneal topography. Results: There was a significant difference between preoperative and postoperative uncorrected visual acuity (UCVA) during the follow up period (p value < 0.001) among both study groups. There was no significant difference in preoperative as well as postoperative intraocular pressure (IOP) or between preoperative and postoperative IOP values in both study groups. There was significant increase in the mean central corneal thickness during first postoperative week in both studied groups (p value <0.001). In MSICS group there was minimal significant increase in astigmatism within the first weak and first month of follow up (p value 0.041). Conclusion: Cataract surgery using phacoemulsification or small incision cataract surgery was found to yield excellent visual results with no significant difference as regards to central corneal thickness, keratometric readings, and postoperative astigmatism or perioperative complications.