Does Istent Inject Affect Toric Intraocular Lens Accuracy? A Comparative Refractive Outcomes Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP04.07 | Type: Free paper | DOI: 10.82333/vdw9-9283
Authors: Dr Michael Ostrovsky* 1 , Dr Asaf Shemer 2 , Prof. Adi Einan-Lifshitz 2 , Dr Biana Dubinsky-Pertzov 2 , Dr Amit Toledano 2
1Ophthalmology,Kaplan Medical Center,Rehovot,Israel, 2Ophthalmology,Shamir Medical Center,Be'er Ya'akov,Israel
Purpose
To evaluate whether combining trabecular micro-bypass with iStent inject affects refractive predictability and rotational stability of toric intraocular lenses (IOLs) in eyes undergoing cataract surgery with coexisting glaucoma and corneal astigmatism.
Setting
Single-center retrospective comparative cohort study at a tertiary referral ophthalmic center.
Methods
Patients were divided into two groups: (1) eyes undergoing phacoemulsification with toric IOL implantation combined with iStent inject (cases, n=31) and (2) eyes undergoing toric IOL implantation alone (controls, n=117). Electronic medical records were reviewed for postoperative refraction, visual acuity, axis alignment, and intraocular pressure (IOP). Prediction error, proportion within target refraction, and need for IOL repositioning were analyzed. Outcomes were assessed on postoperative days 1, 14, and 30, and at final follow-up.
Results
Mean age was 71.96 ± 8.63. BCVA (0.35±0.21 vs 0.40±0.24 logMAR) and biometric parameters were similar between groups (all p>0.050). Secondary IOL rotation requiring repositioning was more frequent in the iStent group (12.9% vs 2.6%; p=0.035). Refractive accuracy was comparable: within ±0.25D (61.3% vs 60.7%, p=0.924), ±0.50D (83.9% vs 80.3%, p=0.667), and ±1.00D (100% vs 99.1%, p=0.608). Achieved sphere, cylinder, and spherical equivalent were similar, with no differences in prediction errors (all p>0.050) or median axis deviation (2.5° vs 2°; p=0.586). Final IOP was lower following iStent implantation (12.30±2.10 vs 13.85±1.26 mmHg, p=0.003), with no change in glaucoma medication burden.
Conclusions
The addition of iStent inject to toric IOL cataract surgery resulted in refractive outcomes comparable to those of the control group, with no difference in prediction error. However, the combined procedure was associated with higher rates of secondary IOL rotation. This potential risk should be discussed with patients as part of the shared decision-making process.