The objective of this study was to compare the development of glaucoma and IOP over an extended time period following cataract surgery in eyes with and without pseudoexfoliation syndrome (PEX), and trying to determine the impact of cataract surgery on glaucoma development. Fifty-one patients with PEX were compared with 102 age- and gender-matched controls without PEX. Patients were re-examined a mean of 76 months after cataract surgery, recording IOP, glaucoma diagnosis, glaucoma treatment and logMAR. Data from the preoperative visit (baseline) and IOP on the first postoperative day were obtained from medical records. A glaucoma parameter was predefined as patients developing glaucoma or needing increased glaucoma treatment during the postoperative time period. One new glaucoma case in each group was diagnosed postoperatively, yielding glaucoma incidences of 0.47 cases per 100 person-years [95% confidence interval (CI) 0.006-2.61] and 0.17 cases per 100 person-years (CI 0.002-0.95) in the PEX and control groups respectively (p=0.53). IOP declined by 2.6 (SD 4.0) mmHg in the PEX group (p<0.001) and 1.9 (SD 3.5) mmHg in the control group (p<0.001) from baseline to the re-examination, with a non-significant group difference (p=0.310). IOP spike (≥6 mmHg increase) was significantly associated with the glaucoma parameter, both within the PEX (p=0.034) and the control group (p=0.044). The study found that the glaucoma incidence was markedly lower than expected in the six to seven years following cataract extraction, especially in the PEX group. Eyes with and without PEX both had a decline in IOP, which is probably associated with the protective effect cataract surgery seems to have on glaucoma development.