AIM: To evaluate the safety of hydroimplantation in cataract surgery in patients with pseudoexfoliation syndrome. METHODS: This prospective randomized study comprised 100 eyes of 100 consecutive patients who underwent cataract surgery and implantation of foldable intraocular lens (IOL). Each eye was assigned to group 1 or group 2. Hydroimplantation without using viscoelastic agent as group 1 (n=50), and hydroxypropylmethylcellulose (Eyevisc, Biotech, India) was used in group 2 (n=50). RESULTS: There were no statistically significant differences in central corneal thickness (CCT) and corneal endothelial cell count (ECC) between both groups at each visit and percentage change in CCT and ECC (P>0.05). The mean intraocular pressure (IOP) at postoperative 5h increased statistically significantly in group 2 (P<0.001). There was no statistically significant difference in IOP between two groups, before and after surgery excluding the 24h postoperative IOP, but patients in group 2 had higher IOP than that in the group 1 at 24h after surgery (P=0.035). No case in either group experienced posterior capsular rupture, or zonular dialysis. Fixation of the globe during IOL implantation was better in group 1 than that in group 2. CONCLUSION: Hydroimplantation has advantages in terms of IOP changes and duration of the surgery and seems to be safe in patients with pseudoexfoliation syndrome.