Intraocular Pressure Control And Medication Reduction Following Mims: A Prospective Case Series

Minimally Invasive Micro-Sclerostomy (MIMS) is a novel, implant-free, ab interno filtering procedure designed to lower intraocular pressure (IOP) by creating a micro-sclerostomy. Unlike device-based MIGS techniques, MIMS provides aqueous outflow without the need for permanent implants. This study evaluates the long-term efficacy of MIMS in reducing IOP, minimizing glaucoma medication dependence, and achieving surgical success based on predefined criteria.

This prospective study is being conducted at the tertiary eye hospital SPKSO in Warsaw, which is equipped with advanced diagnostic and surgical facilities. The study aims to evaluate the effectiveness of Minimally Invasive Microsurgical Surgery (MIMS) as an alternative to traditional filtering procedures in lowering intraocular pressure (IOP) and reducing the reliance on glaucoma medications in patients with primary open-angle glaucoma (POAG).

A prospective, interventional case series included 17 eyes of 17 patients with open-angle glaucoma (OAG), uncontrolled despite maximally tolerated medical therapy. All patients underwent MIMS with intraoperative mitomycin C (0.3 mg/mL). Follow-up visits were conducted at 1 day, 1 month, 3 months, 6 months, and 12 months postoperatively.

Primary outcomes:

Secondary outcomes:

At baseline, the mean IOP was 20.5 ± 3.5 mmHg, with patients requiring an average of 2.7 ± 0.9 medications. At 12 months, mean IOP was 16.0 ± 6.6 mmHg, reflecting a 22% reduction (p = 0.0019, paired t-test).The mean number of glaucoma medications decreased to 0.71 ± 0.99, representing a 74% reduction (p < 0.001). Complete surgical success was achieved in 41.2% of patients (7/17). Qualified surgical success (IOP ≤ 18 mmHg, ≥20% reduction, with or without medications) was achieved in 58.8% of patients (10/17).Medication independence was observed in 58.8% of patients (10/17)Postoperatively, transient iris occlusion at the sclerostomy site was observed in 17,6% of patients (3/17) and managed successfully with pilocarpine and laser iridoplasty. 

MIMS demonstrated a significant and sustained reduction in IOP and medication burdenover 12 months. More than half of the patients achieved surgical success, with a substantial proportion reaching medication independence. The absence of an implant may reduce long-term complications associated with device-based MIGS.

MIMS provides an effective, safe, and implant-free alternative for IOP reduction in glaucoma management. Further long-term, randomized trials are warranted to compare its efficacy with conventional filtration surgery.