A Case Series Evaluating The Early Efficacy And Safety Outcomes Of Minimally Invasive Micro Sclerostomy Using Gonio-Visualisation (Dimims) In Patients With Glaucoma In The Uk

Minimally invasive micro sclerostomy (MIMS^®) is an ab interno, bleb forming, stentless procedure designed to reduce intraocular pressure (IOP) by creating a ~100 μm sclerocorneal drainage channel. It can be performed alone or in combination with cataract surgery. The MIMS device has received the CE Mark, with studies to date demonstrating IOP-lowering efficacy with minimal complications. This prospective, single-centre, case series aimed to evaluate outcomes in patients with glaucoma treated with DiMIMS.

MIMS was performed by one surgeon at the Colchester Eye Centre, UK, in patients with primary open-angle glaucoma (POAG; n=11), primary angle closure glaucoma (PACG; n=3), normal-tension glaucoma (NTG; n=2) and pigment dispersion glaucoma (PDG; n=1). The procedures were conducted between July 2023 and January 2024. Follow-up is ongoing, with data available up to 4 months post-procedure.

Key outcome measures included reduction in IOP, change in glaucoma medications and incidence of adverse events.Patients were selected from a cohort of patients originally listed for trabeculectomy or for treatment with PRESERFLO MicroShunt. MIMS was performed using direct gonio-visualisation, a modified technique where the trephination is performed under constant gonioscopic visualisation (DiMIMS). This ensures clear visualization of the sclerostomy entry point and enhanced stability of the trephination. DiMIMS was performed either alone (5/17) or combined with phacoemulsification (12/17).

Seventeen eyes of 15 patients were treated. Mean ± SD baseline IOP was 19 ± 5 mmHg, and 16/17 (94%) eyes required glaucoma medication (mean no. of medications: 2.0). At Month 2 (n=16) and Month 4 (n=8), mean ± SD IOP was 13 ± 6 mmHg and 16 ± 4 mmHg, corresponding to a 26%, and 21% IOP reduction from baseline, respectively. At Month 2 (n=16) and Month 4 (n=8), the percentage of patients who were taking the same or fewer number of glaucoma medications than baseline was 94% and 88%, respectively. By Month 4, there were two cases of cystoid macular oedema (2/16) which resolved with topical medication, one case of peripheral anterior synechiae blocking sclerotomy (1/16) and two cases of bleb failure (2/16).

In this patient population, DiMIMS effectively reduced IOP and medication count at Month 4 with minimal postoperative complications. This case series suggests that MIMS may be an effective treatment option in patients with glaucoma, including POAG, PACG, NTG and PDG, but longer-term data with a larger patient sample would be needed to support the efficacy and safety of this approach in these patient populations.