Implantation of bitoric MICS IOL after CO-MICS to correct keratoconus


Case study report

Materials and methods

OD: +2.00 -5.50 72 BCVA: 0.25

OS: +2.25 -3.25 138 BCVA: 0.33

After we had discussed different alternatives we decided to implant a bitoric customized toric IOL: AT. Torbi from Carl Zeiss Meditec (Jena, Germany). All the relevant data were entered into the CZM Online Calculator and a customized bitoric IOL was suggested.

The patient's eye reference axis and target axis were marked with a Tabo scheme CZM ocular with the Nd:YAG Laser. We prefer this method in comparison to any marker because it is much more convenient for the patient and can be less influenced by the patient, by rotating the eyeball or retracting the head. After we had done coaxial microincision phacoemulsification (COMICS, OS3 - Oertli Instrumente, Berneck, Switzerland) we implanted the bitoric IOL through a 1.6 mm incision with a wound assisted on axis technique under irrigation without the use of OVD. The orientation of the IOL was checked with a Breyer screen transparency (STACY).

Aberrometry and subjective refraction was tested 2 weeks postop: we achieved a perfect and acceptable result on the OD respective of OS.



The implantation of customized bitoric MICS IOL through a 1.6 mm incision after CO-MICS seems to be a reliable tool to correct astigmatism in keratoconic cataract eyes.

Dr med. Detlev R.H. Breyer is a specialist in cataract and refractive surgery and is senior surgeon at the Breyer Eye Surgery, Dusseldorf, Germany. He may be reached by Email:

Dr Breyer is a consultant to Oertli and Carl Zeiss Meditec.


1. J. Venter, J. Refract. Surg., 2009;25:759–764.

2. K.Kamiya, J. Refract. Surg., 2008;24:840–842.

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