Comparative Analysis Of Intraocular Pressure Changes After Phacoemulsification In Pseudoexfoliation Eyes With And Without Glaucomatous Changes

The objective of this study is to investigate the clinical features of PXF and to evaluate changes in intraocular pressure (IOP) and postoperative complications following cataract surgery, by comparing patients with and without glaucomatous changes. Patients were considered to have glaucomatous changes if they demonstrated optic nerve head damage consistent with glaucoma (e.g., increased cup-to-disc ratio, rim thinning), or required antiglaucoma treatment due to persistently elevated IOP.

This prospective study at Benghazi Eye Hospital included cataract patients with pseudoexfoliation syndrome. Eyes were classified as with or without glaucomatous changes. Preoperative assessment included Goldmann applanation tonometry with corneal thickness correction. All patients underwent standardized phacoemulsification with posterior chamber intraocular lens implantation. Intraocular pressure and postoperative complications were evaluated at day 7 and one month

This study is scheduled to take place at Benghazi Eye Hospital. Two cohorts will be enrolled prospectively: one cohort will consist of PXF eyes that have glaucomatous changes, and the other cohort will consist of PXF eyes without glaucomatous changes. Phacoemulsification will be performed on both groups. The IOP changes and outcomes of these two groups will then be compared. after  7 days and one month from the operation. An independent samples t-test will be used to compare the means between PXF eyes with glaucomatous change and those without glaucomatous change. Statistical analysis will be performed using SPSS for Windows (Version 26).

Eighty-four eyes were analyzed: 41 with glaucomatous changes and 43 without. Preoperative intraocular pressure (IOP) was significantly higher in glaucomatous eyes (22.8 ± 3.6 mmHg) compared with non-glaucomatous eyes (17.2 ± 2.8 mmHg; p < 0.001). At one month, IOP decreased significantly in both groups. Glaucomatous eyes showed a greater reduction (−6.6 mmHg; 28.9%) than non-glaucomatous eyes (−2.7 mmHg; 15.7%) (p = 0.001). Medication burden decreased in 39% of glaucomatous patients. Transient postoperative IOP spikes were infrequent and medically controlled. Intraoperative complications were slightly more common in glaucomatous eyes but without long-term sequelae

Phacoemulsification significantly reduced intraocular pressure in pseudoexfoliation eyes, with greater reduction in those with glaucomatous changes. Cataract surgery provided both visual improvement and meaningful pressure control, with reduced medication need in some patients. Despite surgical challenges, outcomes were favorable. Cataract extraction should be considered part of intraocular pressure management in pseudoexfoliation syndrome