Changes in intraocular pressure and topical anti-glaucoma medication burden after phacoemulsification in medically controlled pseudoexfoliation glaucoma: A prospective cohort study

Objective: To describe short-term changes in intraocular pressure (IOP) and topical antiglaucoma medication burden following uneventful phacoemulsification in selected eyes with medically controlled pseudoexfoliation glaucoma (PXG). Methods: This prospective single-arm before-and-after cohort study enrolled 30 patients with 30 eyes with medically controlled PXG and visually significant cataract who underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation at two tertiary eye hospitals in Baghdad, Iraq, between April 2024 and April 2025. IOP was measured by Goldmann applanation tonometry preoperatively and at 1 week, 1 month, and 4 months postoperatively. Topical antiglaucoma medication burden was recorded before surgery and after postoperative stabilisation. Data were summarised descriptively using means, standard deviations, frequencies, and percentages. Results: Mean IOP decreased from 19.9 ± 2.4 mmHg preoperatively to 15.5 ± 3.2 mmHg at 1 week, 15.4 ± 2.9 mmHg at 1 month, and 14.8 ± 2.7 mmHg at 4 months. The corresponding mean absolute reductions from baseline were 4.4 ± 3.6, 4.5 ± 3.0, and 5.1 ± 2.6 mmHg, respectively. Mean topical antiglaucoma medication use decreased from 2.00 ± 1.15 to 1.43 ± 1.25 medications after postoperative stabilisation, and 9 patients (30.0%) required no topical antiglaucoma medication at that assessment. Conclusions: In this small, selected, uncontrolled cohort, phacoemulsification was followed by lower mean IOP and reduced topical antiglaucoma medication burden over four months. Because the study had no comparator group and perioperative medication regimens were modified, these findings should be interpreted as descriptive postoperative associations rather than evidence of a causal treatment effect.