Purpose <p>To compare postoperative rotational stability of toric intraocular lenses (T-IOLs) following phacovitrectomy with and without gas tamponade.</p> Methods <p>This retrospective observational study evaluated postoperative T-IOL axis rotation at 3 months relative to intraoperative alignment using intraoperative and postoperative anterior segment photographs. Postoperative residual astigmatism, visual acuity, and refractive prediction error were compared between eyes with (gas [+]) and without (gas [−]) gas tamponade.</p> Results <p>A total of 143 eyes of 143 patients (mean age 69.0 ± 9.1 years) who underwent phacovitrectomy with Clareon T-IOL implantation were included. Gas (−) group comprised 90 eyes (mean age 71.3 ± 8.3 years), and gas (+) group comprised 53 eyes (mean age, 65.1 ± 9.3 years). The means for T-IOL axis rotation were 3.4 ± 2.5° and 4.3 ± 3.5° in the gas (−) and gas (+) groups, respectively, without significant difference (<i>p</i> = 0.115). Axis rotation ≥ 10° occurred in 2 eyes (2.2%) and 4 eyes (7.5%) in the gas (−) and gas (+) groups, respectively, (<i>p</i> = 0.194). The means for objective residual astigmatism were 0.74 ± 0.44 and 0.68 ± 0.42 diopters (D) in the gas (−) and gas (+) groups, respectively (<i>p</i> = 0.454). In eyes targeting emmetropia, postoperative uncorrected visual acuity was comparable between groups. Refractive prediction error also did not differ significantly.</p> Conclusion <p>Phacovitrectomy with T-IOL implantation demonstrated comparable rotational stability, residual astigmatism, refractive accuracy, and visual outcomes between eyes with and without gas tamponade use. T-IOL implantation may be a feasible option in selected eyes requiring gas tamponade.</p>