Trabeculectomy is reportedly less effective in aphakic eyes, secondary glaucoma, juvenile patients, and eyes with a history of unsuccessful glaucoma surgery. We evaluated the surgical effects and complications of trabeculectomy with the adjunctive use of mitomycin C, an antiproliferative drug, in a number of refractory cases. Forty patients (50 eyes) with refractory glaucoma were treated with trabeculectomy and the adjunctive use of mitomycin C and were followed postoperatively for at least 3 months. The mean follow-up period was 13.6 +/- 7.5 months (range: 3 to 31 months). In 43 eyes (86%), intraocular pressure was well controlled at < or = 21 mmHg. Complications included corneal epithelial damage (30 eyes), shallow anterior chamber (20 eyes), hyphema (19 eyes), choroidal detachment (18 eyes), leakage of aqueous humor from the conjunctival wound (4 eyes), and endophthalmitis (1 eye). The results of trabeculectomy with intraoperative use of mitomycin C in this series of procedures demonstrates that this can be a useful and effective treatment; however, mitomycin C may cause transient decreased visual acuity due to inhibited wound healing and the resultant overfiltration.