AIM: To compare analysis of the impact of high altitude on corneal endothelial cells, and the prognosis in patients with cataract surgeries. METHODS: Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022 (average altitude=3000 m), and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included. The propensity score matching (PSM) method was applied to match the basic information of patients in both regions on a 1:1 basis. Corneal endothelial cell density (ECD), coefficient of variation (CV), hexagonal cell ratio (HEX), duration of surgery, and pre- and postoperative visual acuity (VA) were compared retrospectively, and correlation tests were done. RESULTS: Totally 223 pairs have been matched successfully. The HEX in the plateau group was higher than that in the plain group (61.95%±6.191% vs 44.91%±6.829%, P0.1). The pre- and postoperative VA of patients with cataract surgeries in the plateau group were lower (1.40±0.610 vs 0.71±0.514, P0.05), while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery (P