PURPOSE In this prospective study, we aimed to investigate the success and safety of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG). PATIENTS AND METHODS The modified 360-degree ST was performed on 15 eyes of 15 patients with XFG resistant to maximal topical treatment. In 6 patients, ST was combined with phacoemulsification. Main outcome measures were the surgical success rate, mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications. RESULTS The mean follow-up period was 8 months (range 6 to 12 mo). Baseline IOP decreased from 27.53±9.38 mm Hg on 3.26±0.70 medications to 12.86±2.72 mm Hg (P=0.01) on 0.20±0.56 medications (P=0.01) at 6 months postoperatively accounting for a 52.82% reduction. The complete and qualified success rates were 77% and 100%, respectively, at the sixth month. The entire circumference of the Schlemm canal was successfully opened in all cases. Hyphema (in all cases), intraoperative iris prolapse (in 3 cases), transient elevation of the IOP (in 1 case), posterior synechia (in 2 phakic cases), and peripheral anterior synechia (in 1 case) were noted. There was not a trend for lower IOP after combined phacomodified 360-degree ST in this small group. CONCLUSIONS The modified 360-degree ST appears to be a valuable option for the surgical treatment of XFG. Future studies are needed to explore the remote side effects and the long-term effects of this procedure on IOP.