The success rate, as deﬁned in this study, was 93% (13/14 patients) with six months of follow-up. All patients experienced a decrease in IOP without the use of hypotensive glaucoma drops. The use of RTA in trabeculectomy with MMC appears safe in a patient population considered at high risk of failure and resulted in well-functioning diffuse blebs. The use of a cannula decreases the risk associated with use of a needle to inject steroids either pre-, peri-, or postoperatively and assures that steroids will reach the site of ﬁltration inde- pendent of adherence to drop therapy. In contrast to injection of steroids adjacent to the bleb at the end of surgery using a needle, our technique allows for the medication to come in direct contact with the bleb surface without creation of an unnecessary conjunctival hole. Further studies will be needed, in a prospective and randomized fashion, to better delineate the utility of retrobulbar steroids combined with MMC in increasing the efﬁcacy of trabeculectomy procedures. Acknowledgments We thank Kira L Lathrop MAMS for her contributions to Figures 1 and 2. Trabeculectomy with retrobulbar steroids Disclosure The authors have no competing interests or disclosures to report. References 1. Chen CW. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C. Trans Asia-Paciﬁc Acad Ophthalmol. 1983;9:172. 2. Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology. 1991;98:317–321. 3. Lama PJ, Fechtner RD. Antiﬁbrotics and wound healing in glaucoma surgery. Surv Ophthalmol. 2003;48:314–346. 4. Araujo SV, Spaeth GL, Roth SM, et al. A ten-year follow-up on a prospective, randomized trial of postoperative corticosteroids after trabeculectomy. Ophthalmology. 1995;102:1753–1759. 5. Giangiacomo J, Dueker DK, Adelstein E. The effect of preoperative sub- conjunctival triamcinolone administration on glaucoma ﬁltration. I. Trab- eculectomy following subconjunctival triamcinolone. Arch Ophthalmol. 1986;104:838–841. 6. Tham CC, Li FC, Leung DY, et al. Intrableb triamcinolone acetonide injection after bleb-forming filtration surgery (trabeculectomy, phacotrabeculectomy, and trabeculectomy revision by needling): a pilot study. Eye. 2006;20:1484–1486. Clinical Ophthalmology 2009:3 31