Aim- The aim of this study is to evaluate and compare the endothelial cell density and cells loss following uncomplicated MSICS (Manual Small Incision Cataract Surgery)andphacoemulsification in grade 2-3 nuclear sclerosis. Methods-This was a retrospectiveconducted at tertiary eye care hospital between June 2023 to December 2023. Total 120 consecutive patients were randomly allocated in to two groups based on type of surgery- Group A: manual SICS (n-60) and group B: phacoemulsification (n-60). Complete Ophthalmic examination was done in form of visual acuity, slit lamp examination, IOP, Specular microscopy by non-contact automated specular microscope pre operatively and post operatively at day 1,day 7 and 6 weeks. Patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm2, known case of diabetes, a history of previous ocular surgery, any other coexisting ocular disease and intraoperative or postoperative surgical complications were excluded. Result- Total 120 patients (60 in each group) were included in the study. Mean age of the patients was 64.25 years±9.53 (SD) in SICS group and 62.50 years ± 8.87(SD) in phacoemulsification group. Endothelial cell density pre operatively was 2509.79 cell/mm2± 340.90(SD) and 2496 cells/ mm2±402.18 (SD) in SICS and phacoemulsification group respectively. Mean cells loss at 6 weeks is 328.46 cell/mm2 ±220.65 (SD)(p=0.011) in SICS group and 342.62 cells/mm2±218.48(SD)(p=0.009) in phacoemulsification group. Both groups have significant cell loss, however no statistically significant difference in endothelial cell loss between the manual SICS group and phacoemulsification group. Conclusion-Safety profile of SICS and Phacoemulsification is same in term of endothelial cells loss. SICS can be use as an alternative to phacoemulsification where trained surgeons for undertaking phacoemulsification or facilities for phacoemulsification are lacking.