Objective: To investigate the correlation between aculity recovery, the the damage degree of corneal endothelial cell (CECs) and nuclear grading in cataract patients with high myopia after phacoemulsification. Methods: A total of 113 cataract patients with high myopia who accepted phacoemulsification voluntarily were selected. The Emery-Little cataract nuclear hardness was graded from II to IV. According to different nuclear grades, the patients were divided into a low nuclear grade group (grade II) and a high nuclear grade group (grade III–IV), with 45 cases and 68 cases respectively. All patients were followed up regularly for 8 weeks. The incidence of corneal edema and the effect of best corrected visual acuity (BCVA) in the 2 groups were observed. The corneal endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal (6A) were compared between the 2 groups. Results: The incidence of corneal edema in the low nuclear grading group (13.33%) was lower than that in the high nuclear grading group (25.86%), but there was no significant difference (P>0.05); BCVA of the 2 groups 1 week and 8 weeks after operation was significantly higher than that before operation (P<0.05) and BCVA in low nuclear grade group was significantly higher than that in high nuclear grade group 8 weeks after operation (P<0.05). Eight weeks after operation, the ECD and 6A of cornea in the 2 groups were significantly decreased, and the corneal CV was significantly increased (P<0.05). The corneal ECD and 6A in the low nuclear grading group were higher than those in the high nuclear grading group 8 weeks after operation, and the corneal CV was lower than that in the high nuclear grading group (P<0.05). Conclusion: Phacoemulsification is an effective method for the treatment of cataract with high myopia, and the postoperative visual acuity recovery and damage degree of CECs are closely related to nuclear grading.