OBJECTIVE To evaluate the long-term results and complications of deep sclerectomy with collagen implant in exfoliative glaucoma (EXG). METHODS A total of 22 eyes of 22 patients with medically uncontrolled EXG were consecutively included in this study and were followed-up prospectively. Intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and slit-lamp examination were performed before and after surgery, at day 1, week 1, and at months 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, and 54. Intraoperative and postoperative complications were recorded and managed accordingly. Complete success was defined as IOP < or =18 mm Hg without antiglaucoma medications and qualified success as IOP < or =18 mm Hg with or without antiglaucoma medications. RESULTS After a mean follow-up time of 48.5+/-12.2 months (range, 12 to 54), mean IOP was significantly reduced from 29.9+/-8.1 mm Hg preoperatively to 13.2+/-3.2 mm Hg (P<0.0001). Complete and qualified success rates were 54.5% and 90.9%, respectively. The mean number of antiglaucoma medications per patient was significantly reduced from 2.4+/-0.67 to 0.59+/-0.85 (P<0.0001). Goniopuncture with Nd:YAG laser was performed on 14 eyes (63.6%). Mean IOP was reduced from 21.8+/-8.8 mm Hg to 9+/-3.2 mm Hg after goniopuncture (P=0.00058). Four eyes (18.2%) required 5-fluorouracil subconjunctival injections and 7 eyes (31.8%) showed cataract progression. CONCLUSIONS Deep sclerectomy with collagen implant seems to provide reasonable long-term IOP control in EXG with few postoperative complications.