[show abstract][hide abstract] ABSTRACT: BACKGROUND: The aim of the study is to compare the outcome of phacoemulsification in patients with and without pseudoexfoliation syndrome in Kashmir. METHODS: 200 patients were prospectively evaluated and divided into 2 groups. Group 1 comprised 100 cases with pseudoexfoliation and Group 2 (control) 100 cases without pseudoexfoliation. Phacoemulsification with posterior chamber intraocular lens implantation was performed by 3 surgeons. Intraoperative and postoperative observations were made in both the groups at regular intervals upto 6 months. A chi square test was used for statistical analysis. RESULTS: Patients with pseudoexfoliation were significantly older (P=0.000), had harder cataract(P=0.030) and smaller mean pupil diameter(P=0.000) than the control group. Intraoperative complications were comparable between the 2 groups except the occurrence of zonular dehiscence which was seen in 7% patients of Group 1 compared to 0% in Group 2. Higher postoperative inflammatory response was seen in Group 1(P=0.000). Decrease in intraocular pressure (IOP) at all postoperative measurements was more in Group 1(P=0.000). The visual acuity was better in the control group in the early postoperative period (P=0.029), however the final visual acuity at 6 months was comparable between the 2 groups. CONCLUSIONS: Phacoemulsification in presence of pseudoexfoliation necessitates appropriate surgical technique to avoid intraoperative complications. Pseudoexfoliation is associated with higher inflammatory response, significant postoperative IOP drop and satisfactory visual outcome.