Background: Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by public hospital. Cataract surgery can be performed by or phacoemulsification or sutureless manual small Incision cataract surgery. Manual small incision cataract surgery is more cost effective Objective: Comparing the morphological (cell density, coefficient of variation and standard deviation) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS). Patients and Methods: Patients were randomly allocated to undergo phacoemulsification (Group A, n = 40) or MSICS (Group B, n = 40). The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively, and after 1 and 6 months postoperatively. Morphological endothelial evaluation was done using Topcon SP- 2000 specular microscope. Phacoemulsification was performed by stop and chop technique. MSICS was performed by the irrigating vectis technique. Results: On comparing between the phacoemulsification and MSICS groups regarding the endothelial cell density, the P value after 1 month and 6 months postoperatively were not statistically significant. The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant. The mean coefficient of variation and mean standard deviation between groups were not statistically significant. Conclusion: Both groups showed comparable endothelial cell loss in the post-operative period. As SICS was economical and less dependent on technology than phacoemulsification, it may be the appropriate surgical procedure for treatment of cataract in the developing world.