Objective To evaluate and compare the clinical effect and safety of phacoemulsification combined with trabeculectomy for acute primary angle-closure glaucoma. Methods A total 67 patients (112 eyes) were divided into trabecular group (group A) and goniosynechialysis group (group B) randomly. Intraocular pressure and central anterior chamber depth before and after surgery, the total treatment effect and postoperative complications was compared. Results Intraocular pressure of all patients recovered after surgery and group B was significantly lower than that of group A at 3 days, 2 weeks, 3, 6 months and 1year after operation (P<0.05). The depth and extent of central anterior chamber in group A were significantly higher than those in group B (P<0.05). Overall, the success rate of operation in group A was 95.3% and group B 90.7%, there was no significant difference between the two groups (P>0.05). Postoperative complications in A group with anterior chamber inflammation, shallow anterior chamber and choroidal detachment were significantly lower than group B (P<0.05). Conclusion phacoemulsification combined with trabeculectomy and phacoemulsification combined with goniosynechialysis to treatment acute primary angle-closure glaucoma with cataract are all safe and effective methods. Among them, trabeculectomy was superior to room angle control in intraocular pressure control. Angle separation was superior to trabeculectomy in central anterior chamber depth and complications control.