Excellent unaided vision on the day after cataract surgery using present day techniques is the expectation of both the patient and the surgeon. One of the reasons that this is not achieved is corneal edema. Although this is often transient and does not interfere with the long-term visual outcome following cataract surgery, in some eyes it can be permanent, necessitating further corneal surgery for rehabilitation. In eyes with conditions like Fuch’s endothelial dystrophy and advanced corneal changes, combining cataract surgery with a corneal replacement procedure is performed, and the factors that aid decision-making in this situation have been discussed in another section. In eyes with a compromised endothelium (see section on corneal evaluation before cataract surgery), it may be possible to minimise surgery induced damage by following certain steps and these will be highlighted in this section. This is extremely important since a study has shown that corneal surgery in eyes with guttate changes may result in 24% endothelial cell loss, compared to about 10% in eyes that do not have these changes.Although these pointers are essential during surgery in eyes with a weak endothelium, they will also help during cataract surgery in eyes with a normal cornea and in those with other factors that increase the technical difficulty of cataract surgery.