ObjectiveTo compare the efficacy and tolerability between nonpenetrating filtering surgery with (NPFS-MMC) and without (NPFS-noMMC) intraoperative mitomycin C application for treatment open angle glaucoma. MethodsPertinent studies were selected through extensive searches of the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Eight controlled clinical trials meeting the pre-defined criteria were systematically reviewed by meta-analysis. The main outcome measures were percentage intraocular pressure reduction (IOPR%), complete remission rate, total remission rate, and complications. The pooled estimates were carried out using RevMan version 5.0 software. ResultsThe weighted mean differences of the IOPR% between the NPFS-MMC group and NPFS-noMMC group were 5.24% (95% confidence intervals\[95%CI\], -3.24 to 13.72) after 6 months, 8.31% (95%CI,4.33 to 12.30) after 12 months(P<0.05), 9.56% (95%CI, 4.88 to 14.24) after 24 months(P<0.05), and 14.45% (95%CI, 9.02 to 19.88) after 36 months(P<0.05). NPFS-MMC was associated with significant greater complete remission rates compared with NPFS-noMMC, with the pooled risk difference being 1.16 (95%CI, 1.05 to 1.27) after 6 months(P<0.05), 1.20 (95%CI, 1.05 to 1.38) after 12 months (P<0.05), 1.30 (95%CI, 1.05 to 1.61) after 24 months (P<0.05), and 1.36 (95%CI, 1.06 to 1.73) after 36 months (P<0.05). Intraoperative mitomycin C was not associated with any drug-induced complications. ConclusionThe use of intraoperative mitomycin C is safe and can improve the effect of nonpenetrating filtering surgery in patients with open ganle glaucoma.