Cataract remains a cause of growing blind worldwide， and phacoemulsification is currently the preferred surgical technique due to its minimal invasiveness and rapid recovery. However， the intraoperative parameters setting of phacoemulsification remains crucial due to their potential impact on ocular tissues， particularly the corneal endothelium and retina. This review systematically examines the effects and interactions of these critical parameters during phacoemulsification， including ultrasonic frequency， infusion bottle height， and ultrasound energy. High-frequency ultrasound enhances emulsification efficiency and reduces operation time but significantly increases localized thermal effects， especially when combined with high-energy output， exacerbating the risk of thermal damage to the corneal endothelium. While a high bottle height stabilizes the anterior chamber， it simultaneously elevates mechanical shear stress and turbulence， further damaging endothelial cells. Conversely， low bottle height combined with low vacuum settings protects endothelial cells but may compromise chamber stability， increasing surgical difficulty. Additionally， oxidative stress and inflammatory cytokines， such as reactive oxygen species （ROS）， vascular endothelial growth factor（VEGF） and interleukin（IL）-6， significantly contribute to tissue injury， particularly pronounced in diabetic and ocular fundus disease patients. Based on current evidence， this article provides specific recommendations for parameter settings tailored to patients with hard nuclear cataracts， compromised corneal endothelial function， diabetes， and postoperative glaucoma. Moreover， this review highlights current research limitations， including high heterogeneity in clinical data， insufficient long-term follow-up， and inadequate mechanistic understanding. Future research should prioritize individualized parameter optimization， long-term clinical outcomes evaluation， and real-time intraoperative monitoring techniques， aiming to enhance surgical safety， reduce complications， and improve visual outcomes.