Précis: iStent Inject implantation (iStent) or Kahook Dual Blade goniotomy (KDB) in combination with phacoemulsification have a similar IOP-lowering effect in all stages of glaucoma, and medications are significantly reduced, especially after KDB.Purpose: To compare the 2-year efficacy and safety of iStent or KDB in combination with phacoemulsification in eyes with mild to advanced open angle glaucoma.Methods: A retrospective chart review of 153 patients that received iStent or KDB in combination with phacoemulsification at a single center between March 2019 and August 2020. The main outcome parameters at 2 years were: (1) intraocular pressure (IOP)-reduction ≥ 20%, with a postoperative IOP ≤ 18 mm Hg, and (2) a reduction of ≥ 1 medication. Results were stratified by glaucoma grade.Results: After 2 years, mean IOP was reduced from 20.3 ± 6.1 to 14.2 ± 4.1 mm Hg in the phaco-iStent group (P < 0.001) and from 20.1 ± 6.1 to 14.7 ± 3.6 mm Hg in the phaco-KDB group (P < 0.001). The mean number of medications was reduced from 3.0 ± 0.9 to 2.6 ± 1.1 in the Phaco-iStent group (P = 0.001) and from 2.3 ± 1.0 to 1.5 ± 1.3 in the Phaco-KDB group (P < 0.001). Success regarding IOP-reduction ≥ 20% with a postoperative IOP ≤ 18 mm Hg was met by 46% in the phaco-iStent group and by 51% in the phaco-KDB group. A reduction of ≥ 1 medication was met by 32% in the phaco-iStent group and by 53% in the phaco-KDB group (P = 0.013). Eyes with mild to moderate and advanced glaucoma responded equally well to the success criteria.Conclusions: iStent and KDB, in combination with phacoemulsification, both lowered IOP effectively in all stages of glaucoma. More medications were reduced after KDB, suggesting that it may be a more effective procedure compared with iStent.

At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.