PURPOSE: To evaluate the efficacy and safety of primary viscocanalostomy for medically uncontrolled juvenile open-angle glaucoma (JOAG). DESIGN: Prospective, noncomparative, interventional case-series study. METHODS: The study included 20 eyes of 20 consecutive patients with medically uncontrolled JOAG who were treated by viscocanalostomy at one institution. No surgical or laser procedure preceded viscocanalostomy. Surgical outcome was defined as an overall success by the following criteria: no visual field deterioration, no optic-neuropathy progression,postoperative intraocular pressure IOP ≤ 20 mm Hg, and IOP reduction < 30% compared with baseline valueswith or without medication. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. RESULTS: Gender distribution was similar. Fourteen eyes belonged to the white race;five eyes belonged to the black race, and one eye belonged to Arab ethnicity. Mean age (± SD) at operation was 33.77± 6.16 years, with the mean preoperative IOP (± SD) at 22.9± 4.77 mm Hg. Thirty-six months after operation, 16 cases (80% ) were considered an overall success. In 11 cases (55% ), success was complete. Four cases (20% ) were considered failures. No serious complications were documented either during or after operation. In two cases (10% ), we documented a spontaneously reabsorbed microhyphema. Trabeculo-Descemet-membrane microperforation occurred in two cases (10% ). In two other cases (10% ), Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy can efficiently and safely reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to conventional surgical modalities. METHODS: The study included 20 eyes of 20 consecutive patients with medically uncontrolled JOAG No surgical or laser procedure preceded viscocanalostomy. An operative outcome was defined as an overall success by the following criteria: no visual field deterioration, no optic-neuropathy progression, postoperative intraocular pressure IOP ≤ 20 mm Hg, and IOP reduction <30% compared with baseline valueswith or without medication. When medications were not required, success was defined as complete. Cases that did not fulfill the complete criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. RESULTS: Gender distribution was similar. Fourteen eyes belonged to the white Mean age (± SD) at operation was 33.77 ± 6.16 years, with the mean preoperative IOP (± SD) at 22.9 ± 4.77 mm Hg. Thirty- Six cases were considered failures. Six months after operation, 16 cases (80%) were considered an overall success. In 11 cases (55%), success was complete. Four cases (20%) were considered failures. Trabeculo-Descemet-membrane microperforation occurred in two cases (10%). In two other cases (10%), Trabeculo-Descemet-membrane microperforation occurred in two cases (10%). In two cases (10%), we documented a spontaneously reabsorbed microhyphema. iris prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy can efficiently and safely reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to conventional surgical modalities.