PURPOSE: This study aims to evaluate the effectiveness and safety of phacoemulsification cataract extraction with intraocular lens implantation (PEI) combined with Goniosynechialysis (GSL), Goni-otomy (GT), and PEI combined with Trabeculectomy (TRAB), in managing mid to late-stage Primary Angle-Closure Glaucoma (PACG) combined with cataract. METHODS: A retrospective analysis was conducted on 42 patients (54 eyes) with mid to late-stage PACG combined with cataracts, who were previously treated at Dongyang People's Hospital from December 3, 2020, to November 30, 2023. Among them, 16 (24 eyes) underwent PEI-GSL-GT, and 26 (30 eyes) underwent PEI-TRAB. After minimum of 6 months of postoperative follow-up, observations were made on intraocular pressure (IOP), best-corrected visual acuity (BCVA), use of antiglaucoma medications, and complications for both surgical procedures. RESULTS: Postoperative BCVA improved significantly in both groups. In the PEI-GSL-GT group, IOP decreased by 26% (from 17.75 to 13.13 mmHg)
in the PEI-TRAB group, it decreased by 14.5% (from 17.87 to 15.27 mmHg). At the 6-month follow-up, IOP was significantly lower in the PEI-GSL-GT group compared to the PEI-TRAB group. The number of patients using antiglaucoma medications decreased significantly in both groups. By the 6-month follow-up, no patients in the PEI-GSL-GT group were using antiglaucoma medications. CONCLUSIONS: PEI-GSL-GT is more effective than PEI-TRAB in lowering IOP in patients with mid to late-stage PACG, potentially reducing or discontinuing postoperative antiglaucoma medications, decreasing postoperative complications, and improving visual acuity.