Study population

Patients diagnosed with PXG with a minimum follow-up period of 2 years were included. In this study, glaucoma was diagnosed based on the presence of glaucomatous optic disc changes and reproducible glaucomatous VF defects. The following defects were identified as glaucomatous optic disc changes: (1) focal or diffuse neuroretinal rim thinning, (2) localized notching, or (3) RNFL defects. Glaucomatous VF defects were defined when two of the following three criteria were present: (1) a cluster of three or more non-edge contiguous points in the pattern deviation plot with a P value of < 1%, without crossing the horizontal meridian; (2) a pattern standard deviation (PSD) of < 5%; or (3) a glaucoma hemifield test result outside the normal limits. PXG was diagnosed based on the presence of pseudoexfoliative material observed on the anterior lens capsule, at the pupillary margin, or both, following mydriasis during slit lamp biomicroscopy examination.

The patients were divided into two groups: PXG with pseudophakic eyes and PXG with phakic eyes. Patients in the pseudophakic eye group underwent uncomplicated cataract surgery with intraocular lens implantation in a capsular bag at least two years prior to the study enrollment. Patients with complications, including intraoperative or postoperative events such as posterior capsular rupture, IOP spike, or endophthalmitis, were excluded from the study. Additionally, patients who underwent any form of glaucoma-related surgery or laser treatment, or had advanced glaucoma (MD < − 20 dB), or presented with cataracts graded ≥ 3 (nuclear color, nuclear opalescence, cortical, and posterior subcapsular cataract) according to the Lens Opacities Classification System (LOCS) III at baseline were excluded. If both eyes were eligible for inclusion, one eye was randomly selected from each patient for analysis. The pseudophakic and phakic eye groups were matched based on the propensity scores using global MD and BCVA as the matching parameters to compare glaucoma progression rates.