Background <p>Medical treatment is ineffective in controlling the intraocular pressure (IOP) in primary angle-closure glaucoma (PACG) with extensive peripheral anterior synechia (PAS), and surgery should be considered. This study aimed to evaluate the efficacy and safety of phacogoniosynechialysis (Phaco-GSL) with viscocanalostomy and Ologen implant for the management of medically uncontrolled PACG with PAS ≥ 270°.</p> Methods <p>This retrospective cohort study included 27 eyes from 27 patients with PACG who had one eye with medically uncontrolled PACG with or without cataract. These eyes had ≥ 270° of PAS, the IOP was above 21 mmHg with maximum topical antiglaucoma treatment or less than 21 mmHg with glaucoma medication intolerance. All eyes were treated with Phaco-GSL combined with viscocanalostomy and an Ologen implant. The follow-up period was one year.</p> Results <p>One year postoperatively, complete success was achieved in 19 cases (70.4%), qualified success in 6 cases (22.2%), and failure in 2 cases (7.4%). The mean decrease in IOP was 13.33 ± 4.07 mmHg, the mean reduction of antiglaucoma medications was 2.74 ± 1.10, and the mean percentage of reduction in IOP was 48.11 ± 9.85%. There was a statistically significant decrease in IOP and antiglaucoma medications. Malignant glaucoma occurred in three patients. It was treated successfully; other complications were trivial. Goniopuncture was needed after surgery in 18 eyes (66.7%) to control the IOP.</p> Conclusion <p>Phaco-GSL with viscocanalostomy with Ologen implant is an effective procedure in PACG to reach the target IOP and decrease the number of antiglaucoma medications.</p>