Mitomycin is an antibiotic with antineoplastic activity which inhibits fibroblast proliferation in the operative field in glaucoma filtering surgery. The authors retrospectively evaluated the effectiveness of trabeculectomy with mitomycin-C as an initial surgical procedure in uncomplicated (primary open angle) glaucoma in 17 eyes of 17 patients; 12 eyes of 12 patients that received standard trabeculectomy constituted the control group. Mitomycin was applied at a concentration of 0.5 mg/ml for 3 min to the episclera and 2 min under the scleral flap. Median values for preoperative intraocular pressure was 43 mmHg (range 26-65) in the control group and 40 mmHg (range 30-60) in the mitomycin group (p > 0.05, Mann-Whitney U-test). After an average follow-up of 17 months, median postoperative IOP was 10 mmHg (range 3-18) in the control group and 4 mmHg (range 1.1-20) in the mitomycin group (p < 0.05, Mann-Whitney U-test). Percentage IOP drop was 75.6% in the control group (range 30.8-93.5%) and 89.6% (range 54.2-98%) in the mitomycin group (p < 0.05, Mann-Whitney U-test). The postoperative visual acuities of the two groups did not differ significantly (p > 0.05, Fisher exact test). Although there was not a statistically significant difference between complications, such as elevated intraocular pressure, wound leakage or bleb ulceration in both groups (p > 0.05, Fisher exact test), the number of hypotonous eyes (having an average IOP < or = 5 mmHg) was significantly higher in the mitomycin-C group compared to the controls (p < 0.05, Fisher exact test). Mitomycin established a well formed bleb and reduced the IOP more effectively than did the standard filtering procedure (p < 0.05, Mann-Whitney U-test); however, further work is necessary to evaluate the long-term complications of mitomycin-C surgery such as hypotony. This would help clear any doubts about the safety of this procedure on long-term.