To compare intraoperative and postoperative complications, best corrected visual acuity, intraocular pressure (IOP), and glaucoma medication requirements between eyes with clinically apparent pseudoexfoliation (PEX) and fellow eyes without PEX in patients having bilateral cataract surgery. Private practice, Boston, Massachusetts, USA. This retrospective study comprised 1000 consecutive patients who had cataract surgery performed by the same surgeon. Of the 1000 patients, 137 had unilateral PEX and bilateral cataract surgery. Patients with previous or concurrent glaucoma surgery were eliminated from the study. Two-way analysis of variance and Tukey post hoc tests were used for statistical analysis. Complications were few, with no significant differences between the 2 groups intraoperatively (zonule instability) or postoperatively (corneal edema, cystoid macular edema, intraocular lens decentration). Both groups had improved visual acuity, with no statistically significant between- group difference in acuity at 1 year. Both groups had decreased IOP postoperatively, although the eyes with PEX had a significantly greater mean Delta IOP than the fellow eyes without PEX (P<.016). The PEX group required more glaucoma medications overall (P<.003) and needed more glaucoma medications at 3 to 5 years than preoperatively; the medication requirement in the fellow-eye group remained stable. The presence of clinically apparent PEX had an impact on IOP reduction and glaucoma medication requirements. There were no differences in intraoperative or postoperative complications between eyes with PEX and fellow eyes without PEX.