Background <p>This study aimed to evaluate the safety of anterior chamber air tamponade post-phacoemulsification on the cornea compared to balanced salt solution or Ringer’s lactate filling, and summarize its potential influence on the aspects like the risk of postoperative endophthalmitis and Descemet’s membrane detachment (DMD).</p> Methods <p>This meta-analysis was conducted using Review Manager 5.4 and included studies that evaluated post-phacoemulsification air tamponade compared with no air tamponade before October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool. This review was registered in PROSPERO (CRD420251177446) and followed PRISMA guidelines.</p> Results <p>Among seven included studies (1340 eyes), there were no significant between-group differences (mean difference [95% confidence interval]) at 1 month, with or without air tamponade, in the endothelial cell density (−103.59 [−256.86 to 49.68] cells/mm²; <i>p</i> = 0.19), central corneal thickness (−4.86 [−19.81 to 10.08] µm; <i>p</i> = 0.52), or coefficient of variation of the corneal endothelial cell size (−0.01 [−0.04 to 0.01]; <i>p</i> = 0.22). A minimal yet significant difference in hexagonality favored the no-air-tamponade group (−0.01 [−0.03 to −0.00]; <i>p</i> = 0.03).</p> Conclusions: <p>Intracameral air injection demonstrated comparable short-term corneal endothelial safety, with the potential added benefits of reduced inflammation and infection risk and of protection of the Descemet’s membrane.</p> Trial registration <p>PROSPERO, CRD420251177446. Registered 2025.</p> Clinical trial number <p>Not applicable.</p>