. Purpose:  To compare the efficacy of the dispersive‐viscoadaptive soft‐shell technique using Viscoat® and Healon®5 to the dispersive‐cohesive soft‐shell technique in reducing corneal endothelial cell damage during cataract surgery. Methods:  In this prospective randomized study, 207 eyes of 171 cataract patients underwent phacoemulsification using the dispersive‐viscoadaptive soft‐shell technique (V‐group, 102 eyes) with Viscoat and Healon5 or the dispersive‐cohesive soft‐shell technique (C‐group, 105 eyes) with Viscoat and a cohesive agent (Opegan‐Hi®). Each group was divided into two subgroups depending on the amount of ultrasound (%Min) used during phacoemulsification. Corneal endothelial cell density was examined preoperatively and 3 months postoperatively. The endothelial cell loss was compared between the two groups, and also between the subgroups. Results:  The mean endothelial cell loss 3 months after surgery was 8.4 ± 5.6% standard deviation (SD) in the V‐group and 8.2 ± 6.2% in the C‐group (P = 0.787). In the subgroups with ultrasound of 10 %Min or less, the mean endothelial cell loss 3 months after surgery was 6.6 ± 4.6% in the V‐group and 5.5 ± 5.0% in the C‐group (P = 0.104). In the subgroups with ultrasound of over 10 %Min, this value was 10.6 ± 6.3% in the V‐group and 11.9 ± 5.7% in the C‐group (P = 0.413). The correlation coefficient of the endothelial cell loss rate and %Min was 0.245 (P = 0.0129) in the V‐group and 0.501 (P < 0.0001) in the C‐group. Conclusion:  The dispersive‐viscoadaptive soft‐shell technique is as effective as the dispersive‐cohesive soft‐shell technique in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.

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