Impact of phacoemulsification with posterior chamber intraocular lens implantation on intraocular pressure and retinal structural parameters in pseudoexfoliation glaucoma and primary open-angle glaucoma

Background: Glaucoma, a leading cause of irreversible blindness, is increasingly prevalent, with pseudoexfoliation glaucoma (PEXG) presenting more severe optic nerve damage than primary open-angle glaucoma (POAG). Phacoemulsification reduces intraocular pressure (IOP), especially in PEXG; however, its effects on retinal structure remain unclear. This study compared the effects of IOP reduction post-phacoemulsification on the ganglion cell complex (GCC) in eyes with PEXG and cataract, POAG and cataract, and cataract alone over 12 months. Methods: This prospective, quasi-experimental study included age- and axial length-matched patients with PEXG, POAG, or cataract alone undergoing standardized phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation by a single surgeon using consistent techniques. Comprehensive ophthalmic assessments and spectral-domain optical coherence tomography imaging were performed preoperatively and at 3, 6, and 12 months postoperatively. Outcome measures included IOP, GCC thickness, retinal nerve fiber layer (RNFL) thickness, and vertical cup-to-disc ratio (CDR). Results: Ninety eyes (30 per group) were analyzed. The mean (standard deviation [SD]) ages were 57.8 (5.8) years in the PEXG group, 58.0 (6.3) years in the POAG group, and 56.2 (4.6) years in the control group. There were 14 men (46.7%) and 16 women (53.3%) in both the PEXG and POAG groups, and 12 men (40.0%) and 18 women (60.0%) in the control group. The mean (SD) axial lengths were statistically similar at 23.9 (1.2) mm in the PEXG group, 23.9 (1.8) mm in the POAG group, and 23.8 (1.2) mm in the control group. Preoperatively, the PEXG group displayed higher IOP and thinner RNFL, whereas the POAG group featured thinner GCC and greater vertical CDR. Phacoemulsification significantly reduced IOP in both glaucoma groups (both P < 0.05), with a greater reduction in PEXG. However, no significant postoperative changes were observed in GCC thickness, RNFL thickness, or vertical CDR within any group (all P > 0.05). Despite this, intergroup differences in GCC, RNFL, and vertical CDR persisted at all follow-up points (all P < 0.05), although the PEXG and POAG groups did not significantly differ from each other (P > 0.05). Conclusions: Phacoemulsification with PCIOL implantation significantly reduced IOP in eyes with PEXG and POAG, with a greater reduction observed in PEXG. However, this IOP reduction did not translate into significant changes in GCC thickness, RNFL thickness, or vertical CDR over 12 months. These findings suggest that although cataract surgery offers IOP-lowering benefits in early-stage glaucoma, it may not influence short-term structural progression, highlighting the need for ongoing postoperative monitoring and adjunctive management in glaucomatous eyes.