AIM: To explore the effect of persistent high intraocular pressure (IOP) on cataract surgery in eyes with acute primary angle-closure glaucoma (PACG)and its correlative factor, and to discuss the choice of treatment for persistent high IOP. METHODS: Totally 284 cases(293 eyes) were diagnosed as acute PACG and underwent cataract surgery. According to preoperative IOP, these patients were divided into three groups: Group 1(188 eyes), Group 2 (61 eyes) and Group 3(44 eyes). Group 1 was defined that preoperative IOP can be controlled within the normal range under systemic and local drug. Group 2 was defined that preoperative IOP higher than 40 mmHg after drug therapy, which can be controlled after an anterior chamber puncture treatment. Group 3 was defined that preoperative IOP higher than 40 mmHg after multiple anterior chamber puncture. Group 1 underwent cataract extraction and intraocular lens (IOL) implantation. Group 2 and Group 3 underwent cataract extraction and IOL implantation with goniosynechiolysis. The preoperative and postoperative visual acuity, IOP, anterior chamber depth(ACD) and subfoveal choroidal thickness were obtained, and gonioscopic measurement of chamber angle was recorded. Preoperative and postoperative measurements were compared using non-parametric tests. RESULTS: After surgical treatment, the rate of postoperative one-week IOP control rate was respectively: Group 1 (100%), Group 2 (95%), Group 3 (82%) (the rate of Group 2 is higher than Group 3, χ2=4.795, P<0.05). The rate of the improved postoperative vision was respectively: Group 1 (92%), Group 2 (84%) and Group 3 (52%). Postoperative central anterior chamber depth of each group deepened obviously compared to preoperative, but the postoperative goniosynechia range of Group 3 was significantly wider than that of Group 1 and Group 2. Group 1 and Group 2 did not record postoperative hyphema, while 18% of Group 3 had recorded hyphema. CONCLUSION: Acute PACG eyes with persistent high preoperative IOP had good effects after cataract surgery, but demonstrated wider goniosynechia range and higher risk of hyphema compared to eyes with normal preoperative IOP. Copyright 2019 by the IJO Press.