Abstract: Objective To compare clinical effect of phacoemulsification and extracapsular cataract extraction with small incision in patients with cataract and high myopia. Methods A total of 100 patients with cataract and high myopia who underwent surgeries were selected, and were randomly divided into study group(extracapsular cataract extraction with small incision)and control group(phacoemulsification), with 50 cases in each group. The clinical effects and changes of corneal endothelial cells were compared between the two groups. Results The incidence of corneal edema in the study group was 14.00%, which was significantly lower than 32.00% in the control group(P<0.05). The visual acuity after operation was significantly higher than that before operation(P<0.05), but there was no between-group significant difference before and after operation(P>0.05). The ratios of hexagonal cells in pupillary zone and corneal endothelial cell density in the pupil area after treatment were significantly lower in the two groups than those before treatment(P<0.05), but there were no between-group significant differences before and after treatment(P>0.05). Conclusion Phacoemulsification and extracapsular cataract extraction with small incisionare are both effective clinical procedures in the treatment of cataract and high myopia, they can significantly improve the visual acuity of patients, but the latter procedure can reduce the incidence of postoperative corneal edema, and has higher safety.