To evaluate intraoperative and postoperative complications of phacoemulsification and intraocular lens (IOL) implantation in eyes with exfoliation syndrome.Eye Clinic, University Hospital of Geneva, Switzerland.This prospective study evaluated 20 consecutive patients with exfoliation syndrome and 20 consecutive patients without the syndrome (control group) who had phacoemulsification and posterior chamber IOL implantation. One year later, the incidence of zonular tears, operating time, and fibrinoid reaction were studied in another group of 23 consecutive patients who had the same type of surgery by the same surgeon.Maximal pupil dilation was significantly smaller (P < .0001) in the exfoliation than in the control group. Intraoperatively, the incidence of zonular tears was the same in both groups (10%). In the 23 patients who had surgery 1 year later, no zonular tears occurred. The incidence of postoperative complications was similar in both groups. The exfoliation group had a significant decrease in intraocular pressure over preoperative levels at 1 week and 3 months postoperatively.Phacoemulsification with posterior chamber IOL implantation appears to be safe in eyes with exfoliation syndrome.