Refractive Outcomes of Uneventful Cataract Surgery in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Purpose: To compare the refractive outcomes after cataract surgery between patients with and without pseudoexfoliation, and to evaluate the risk factors of refractive error. Methods: Retrospective review of 210 eyes with pseudoexfoliation (study group) and 510 normal eyes (control group) that underwent uneventful phacoemulsification with intraocular lens implantation. The study group included pseudoexfoliation syndrome and pseudoexfoliation glaucoma (PXG) subgroups. The main outcome measure was refractive error, defined as the difference between the target refraction and postoperative refraction in diopter (D). A refractive error >±1.0 D was identified as a large-magnitude refractive error. The frequency of the large-magnitude refractive error was compared between study and control groups, and also between each subgroup and normal eyes. The factors influencing refractive error were analyzed by logistic regression. Results: There was a significantly higher frequency of a refractive error >± 1.0 D and hyperopic error >1.0 D in the study group than in the control group (p = 0.001 and p = 0.003, respectively). In the multivariate logistic regression analysis, PXG and poor preoperative visual acuity were related with a large-magnitude refractive error (p = 0.001 and p = 0.02, respectively) Refractive error >± 1.0 D and hyperopic error >1.0 D were noted more often in PXG eyes that had an intraocular pressure spike >25 mmHg at postoperative first 24 hours (p = 0.01 and p=0.03, respectively). Conclusions: The eyes with pseudoexfoliation were at a high risk for refractive error, especially in the presence of glaucoma. In PXG, the only significant risk factor for refractive error was observed to be the presence of an intraocular pressure spike.