Purpose <p>This study aims to compare one-year results and success rates of trabeculectomy and gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with long axial length (AL) and glaucoma.</p> Method <p>This retrospective study included patients with an AL greater than 24 mm who underwent trabeculectomy (29 eyes) or GATT surgery (33 eyes) in our hospital and had at least a one-year follow-up. Complete success was defined as achieving an IOP &gt; 5 and ≤ 21 mmHg (criterion A), &gt; 5 and ≤ 18 mmHg (criterion B), or &gt; 5 and ≤ 15 mmHg (criterion C), without the use of antiglaucoma medications or additional surgical interventions, except for bleb needling. The same IOP levels with or without medication were considered as overall success.</p> Results <p>The GATT group required significantly more antiglaucoma medications at the 1-week, 1-month, and 3-month follow-ups (<i>p</i> &lt; <i>0.05 for all).</i> Complete success rates were higher in the trabeculectomy group based on criteria A, B, and C (<i>p</i> &lt; <i>0.05 for each</i>), and the overall success rates based on criteria A, B, and C were similar in both groups in one-year follow-up (<i>p</i> &gt; 0.05 for each). The failure rates based on all three criteria were similar in both groups (<i>p</i> &gt; 0.05 for each). The cumulative probability of overall success based on criterion B was 93.1, 86.2 and 79.3% at 3, 6 and 12 months in the trabeculectomy group and 90.9, 84.5 and 81.8% at 3, 6 and 12 months in the GATT group. The incidence of postoperative complications was higher in the GATT group, and the majority of complications were haemorrhage-related.</p> Conclusion <p>In eyes with long AL, the requirement for antiglaucoma medications&#xa0;is reduced in the first three months following trabeculectomy compared to GATT. Although the overall success rate was similar in both groups, the complete success rates of criteria A, B and C were higher in the trabeculectomy group. GATT may be considered an alternative in eyes with long AL.</p>