Two Cases of Trocar Bending of the Injector During iStent Inject W Implantation

We report two cases of trocar tip bending during implantation of the iStent inject W in combination with cataract surgery. In both cases, the trocar within the insertion tube was bent at a similar location and direction. In Case 1, the bending was recognized after stent deployment, although surgical video review confirmed that it had already been present before deployment. In Case 2, the bending was identified prior to insertion of the injector tip into the anterior chamber. In both cases, the stents initially failed to be properly implanted, and successful implantation was achieved using a new injector. Postoperative courses were uneventful except for transient hyphema. Stereomicroscopic examination revealed that the trocar was bent approximately 0.9-1.0 mm from the tip. These findings suggest that bent-type trocar damage can occur when the exposed trocar tip catches on the corneal stroma during passage through the corneal incision, particularly with the iS2 injector system. Recognition of this damage before stent deployment and prompt replacement of the device are essential to avoid improper implantation and ensure surgical safety.