Objective: To compare the clinical efficacy and prognosis of intra-aqueous access reconstruction combined with phacoemulsification and glaucoma valve implantation combined with phacoemulsification in the treatment of primary open-angle glaucoma with cataract. Methods: A total of 152 patients with primary open-angle glaucoma and cataract were selected. They were divided into two groups based on the different treatment methods: group A (n=76) received glaucoma valve implantation combined with phacoemulsification, and group B (n=76) received intra-aqueous access reconstruction combined with phacoemulsification. The intraocular pressure, best corrected visual acuity, anterior chamber depth (ACD), thickness of the ganglion cell complex (GCC) in the macular area, central corneal thickness (CCT), corneal endothelial function indicators, and complications were compared between the two groups. Results: Compared with before the operation, 1 month after the operation, both groups showed a reduction in intraocular pressure. However, there was no significant difference in intraocular pressure between the two groups (P>0.05). The best corrected visual acuity of the operated eyes in group B was lower than that in group A (P<0.05), and the ACD was higher in group B (P<0.05). The GCC in group B was higher than that in group A, while the CCT was lower than that in group A (P<0.05). 1 month after the surgery, the density of corneal endothelial cells and the proportion of hexagonal cells in group B were both higher than those in group A (P<0.05). Compared with group A, the coefficient of variation of corneal endothelial cells in group B was smaller (P <0.05). There was no statistically significant difference in the overall incidence of complications between the two groups (P >0.05). Conclusion: Reconstruction of intra-aqueous access reconstruction combined with phacoemulsification for patients with primary open-angle glaucoma and coexisting cataract effectively lowers intraocular pressure, restores visual function, mitigates corneal endothelial cell damage, and does not increase the incidence of postoperative complications.