Purpose <p>To assess the surgical outcomes of visco-circumferential-suture-trabeculotomy-synechiolysis (VCSTS) with phacoemulsification compared with phacoemulsification alone for the treatment of chronic primary angle closure glaucoma (PACG).</p> Settings <p>Mansoura Ophthalmic Center, Mansoura, Egypt.</p> Design <p>Retrospective double armed interventional non randomized comparative study.</p> Methods <p>A total of 88 eyes (69 patients) with uncontrolled PACG between 2016 and 2022 were subjected to VCSTS with phacoemulsification (Group 1) or phacoemulsification (PE) alone (Group 2). The follow-up period was 24 months. Success was defined as an IOP between 6 and 18 mmHg, with a reduction of at least 30% from baseline with (qualified) or without (complete) antiglaucoma medications (AGMs).</p> Results <p>The mean ± standard deviation ages of the study patients in groups 1 and 2 were 61.1±0.9 and 61.7±0.8 years (p=0.536), respectively. The means ± standard deviations of the preoperative and final postoperative IOP and AGM in groups 1 and 2 were 27.46±0.32 and 28.0±0.3 and 14.15±1.1 and 16.7±0.71 mmHg, respectively (p&lt;0.001), and 3.18±0.07 and 3.2±0.9 and 0.47±1.1 and 1.1±1.5, respectively (p=0.035). The rates of complete success (Kaplan‒Meier) in groups 1 and 2 were 95.3% and 86.7%, respectively (p=0.153). Mild self-limited hyphema was the most common complication in Group 1, with no serious complications reported in Group 2.</p> Conclusions <p>Phacoemulsification results in a significant and sustained reduction in IOP and the need for AGMs for at least 2 years of follow-up. The addition of VCSTS to phacoemulsification provides a greater reduction in IOP and AGMs and improved surgical success without serious complications.</p>