Aim — to identify indications and evaluate the efficacy of combined endotrabeculectomy and phacoemulsification surgery. Material and methods. A total of 172 patients (193 eyes) with open-angle glaucoma and cataract were enrolled. Group 1 included 102 patients (118 eyes), who were considered surgical candidates due to decompensation of IOP, group 2 — 70 patients (75 eyes), in whom IOP control could only be achieved with a multidrug regimen (two or more ocular hypotensive medications). The mean preoperative IOP measured with Maklakov tonometer was 26.4±1.8 mmHg in group 1 and 20.5±1.7 mmHg in group 2. In 134 eyes the extent of retention of intraocular fluid was determined intraoperatively by provoking blood reflux into Schlemm’s canal. Results. In 6 out of 134 eyes (4.5%) Schlemm’s canal was not at all filled with blood, which was considered a contraindication for endotrabeculectomy. Partial filling of Schlemm’s canal with blood was observed in 26 out of 134 eyes (19.4%), complete — in 102 eyes (76.1%). All but 6 patients underwent endotrabeculectomy (ab interno trabecular excision with original forceps through the anterior chamber angle) combined with cataract phacoemulsification and intraocular lens implantation. In 11 out of 126 cases, insignificant bleeding occurred during sample acquisition. No other complications were registered. Six months after the surgery, IOP was reduced by the mean of 7.0±0.6 mmHg (26.5% from the baseline) in group 1 and by 2.2±0.2 mmHg (10.7% from the baseline) in group 2. The number of hypotensive medications by that time has been decreased from 2.3±0.3 to 0.8±0.2 in group 1 and from 1.6±0.3 to 0.4±0.1 in group 2. Conclusion. Combined endotrabeculectomy and phacoemulsification surgery is a pathogenically oriented procedure, which improves ocular hydrodynamics and has a significant hypotensive effect.