Purpose <p>To evaluate the influence of postoperative inflammation on visual and refractive recovery after cataract surgery and the effect of subconjunctival dexamethasone injection (Dex) at the end of surgery.</p> Methods <p>This retrospective comparative cohort study included 112 eyes of 112 patients undergoing phacoemulsification with the same intraocular lens (IOL) by a single surgeon; 57 eyes received Dex and 55 did not, and the groups were compared. Correlations were analyzed between aqueous flare (Flare) change from postoperative day 1 to week 1 (Flare1d-1w) and visual and refractive parameter changes from day 1 to month 1 (1d-1m). Multivariate regression was performed to evaluate factors associated with postoperative visual and refractive outcomes.</p> Results <p>Flare1d-1w correlated with best-corrected visual acuity (BCVA)1d-1m (<i>p</i> &lt; 0.0001, <i>r</i> = 0.63), central corneal thickness (CCT)1d-1m (<i>p</i> &lt; 0.0001, <i>r</i> = 0.83), and anterior chamber depth (ACD)1d-1m (<i>p</i> &lt; 0.0001, <i>r</i> = -0.53). In multivariate analysis, CCT1d-1m was significantly associated with BCVA1d-1m, whereas ACD1d-1m was retained in the model for refractive prediction error at 1m, but did not reach statistical significance. Dex(+) eyes showed smaller Flare1d (<i>p</i> &lt; 0.0001), Flare1w (<i>p</i> = 0.0037), and Flare1d-1w (<i>p</i> = 0.0287), and earlier recovery of vision and refraction than Dex(−). Dex(−) eyes had deeper ACD1m.</p> Conclusions <p>Postoperative inflammation was associated with delayed visual and refractive recovery. Dex was associated with less postoperative inflammation and earlier recovery within the first month.</p>