In an observational study 19 eyes with cataract and coexisting primary open angle glaucoma were scheduled to undergo combined procedure with ECCE-IOL and trabeculectomy. The aim of the present study was to investigate the results and the efficacy of combined surgery, when we extended the indication for surgery. Thus the surgical decision making was not based solely upon IOP readings, but also involved social/psychological factors. Median decrease in IOP (IOPpost-IOPpre) was significant through a 12-month observation period, p < 0.001. The number of medications dropped from 1.74 to 0.21, p < 0.01. Complication rate during operation and in the postoperative follow-up period was low. We conclude that it seems justified to extend the indication for combined surgery in cataract patients with coexisting open angle glaucoma in case of uncontrolled IOP, poor compliance, inability of sufficient medical care, or unacceptable medication. We recommend careful monitoring of the early postoperative IOP, even if hypotensive agents are given prophylactically.