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Introduction/Objective. Pseudoexfoliation syndrome (PEX) is an age-related systemic disorder characterized by deposition of fibrillary white flaky material mainly on the lens capsule, corneal endothelium, zonules, ciliary body, iris, and pupillary margin. Zonular weakness progressively increases along with the hardness of the lens, patient’s age, and the presence of glaucoma. The objective of the study is to compare the intraoperative and postoperative complications of phacoemulsification in cataract eyes with PEX with cataract eyes without PEX. Methods. The study enrolled 300 eyes with consequently operated senile cataract and PEX and 300 consequently operated eyes with cataract without PEX who underwent phacoemulsification performed by one experienced surgeon (single-surgeon series). A complete ophthalmological examination of all patients was performed preoperatively, as well as on the first, seventh, and 180th day postoperatively. Results. Significant statistical differences between the observed groups were the following: patients with PXF were older (74.2 ± 8; range 56–82 years vs. 68.1 ± 9.6; range 56–79 years), had smaller pupil diameter, and higher intraocular pressure (IOP) preoperatively (16.1 ± 4.1 vs. 13.8 ± 3.7 mmHg). There were no differences between the groups regarding intraoperative complications. Early postoperative complications were a significant rise of IOP (33 vs. six patients; p < 0.001), more frequent postoperative corneal edema (36 vs. 21 patients; p < 0.036), and anterior chamber inflammation (17 vs. seven patients; p < 0.037) in the PEX group, comparing to the control group. The significant late postoperative complication was elevated IOP (24 vs. five patients; p < 0.0002) in patients with PEX. Conclusion. In the hands of an experienced and careful surgeon, phacoemulsification is a safe and beneficial surgery to treat cataract with associated pseudoexfoliation. The greatest problem a surgeon faces is a narrow pupil and zonule instability, and difficulty in recognizing eyes that are particularly at risks, such as those having glaucoma and phacodonesis

Intraoperative and postoperative complications of phacoemulsification in cataract eyes with pseudoexfoliation syndrome