Objective    To investigate the clinical effects and indications of phacoemulsification and soft intraocular lens (IOL) implantation combined with viscogoniosynechialysis in the management of primary angle closure glaucoma (PACG).     Methods    Forty-six eyes of primary angle closure glaucoma with co-existing cataract were treated with phacoemulsification and IOL implantation combined with goniosynechialysis. The mean follow-up duration was 9 to 24 months. The main outcome measures were pre-operative and post-operative changes of intraocular pressure

visual acuity

depth of anterior chamber

anterior chamber angle

outflow facility of aqueous humor (C values) and PO/C ratio

and the number of glaucoma eye drops required.     Results    Compared with pre-operation

intraocular pressure was decreased (paired t test

P0.001)

visual acuity was improved (P0.01)

depth of anterior chamber was deepened (paired t test

P0.001) and anterior chamber angle of 36 eyes (78.26%) was open

outflow facility of aqueous humor (C values) and PO/C ratio were improved (paired t test

P0.01)

and the number of glaucoma eye drops required was decreased (paired t test

P0.01). Seven eyes (15.21%) had to undergo trabeculectomy because intraocular pressure was over 25 mmHg after phacoemulsification.     Conclusion    Phacoemulsification combined with viscogoniosynechialysis is an effective and safe surgical procedure in managing primary angle-closure glaucoma with co-existing cataract. However

trabeculectomy may be necessary for the cases with peripheral anterior synechia more than 270 degrees.