Introduction. In 1994, academician S.N. Fyodorov directed the development of laser cataract extraction (LCE) technique, which does not require manual or ultrasonic lens fragmentation. Purpose — to determine the effectiveness and safety of Russian LCE technology in patients with diabetes mellitus using comparative analysis, and to develop practical guidelines. Material and methods. The study analyzed the results of 154 operations in patients with complicated cataract and diabetes mellitus (DM). 80 LCE operations and 74 ultrasonic cataract phacoemulsification (PhEC) surgeries including implantation of intraocular lens were performed. The duration of DM was 12.5±7.1 years in the LCE group and 11.9±7.3 years in the PhEC group. The energy of neodymium Nd:YAG laser endo-dissector with original wavelength of 1.44 μm together with low-intensity He-Ne laser radiation of 0.63 μm were delivered simultaneously to the eye cavity. Results. Corneal endothelial cells loss was significantly lower (by 1.8 times) after LCE, in the early postop period, in 1 year, and 2 years after the surgery; the incidence of intraocular pressure increase and ciliary body edema were lower as well. Moreover, there is no negative influence on the posterior segment of the eye because the radiation of laser endo-dissector during the duty cycle of cataract removal does not extend beyond the lens capsule, and does not affect other tissues of the eye. Conclusion. In comparison to ultrasound cataract surgery, LCE is a more safe and effective method of removing complicated cataracts in diabetic patients with any degree of lens density.