PURPOSE: To compare precision in toric intraocular lens (TIOL) alignment and refractive outcomes between an intraoperative automated digital marker system and the conventional manual-ink marking. MATERIALS AND METHODS: Prospective single center study including consecutive patients undergoing uneventful cataract surgery with corneal astigmatism greater than 1 diopter. Total corneal astigmatism was measured using a placido-dual Scheimpflug system (GalileiG4((R)), Ziemer). Acrysof((R)) SN6AT (Alcon) TIOL's were implanted, and patients were divided into 2 groups, the digital group (Verion((R)), Alcon) and the ink-marking group (Pendular marker, AMO). Mean error in TIOL axis, visual acuity and residual astigmatism were analyzed at 3 days, one month and 6 months after surgery. RESULTS: In total, 45 eyes of 30 patients were included (n=25 digital group, n=20 ink-marking group). The mean preoperative total corneal astigmatism was 1.71+/-0.53 diopters. At one month, there was a significantly lower mean average error in TIOL axis in the digital group compared to the ink-marking group (2.6+/-2.3 degrees and 6.4+/-2.8 degrees respectively, P=0.009). At 6months, these results remained statistically significant. Mean residual astigmatism was 0.7+/-0.4 diopters at one month, without significant difference between the two groups (P=0.9). The rate of misalignment less than or equal to 5 degrees was 86 % (n=25) in the digital group and 63 % (n=20) in the ink-marking group (P=0.05). CONCLUSION: Intraoperative digital marker system is associated with better TIOL alignment accuracy and better reproducibility than the manual ink-marking method.Read less <