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Background  To compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism.    Methods  This study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years.    Results  Preoperatively, the mean manifest spherical equivalent (SE) was −14.14 ± 2.12 D in the TICL group and −14.83 ± 2.79 D in the AK + ICL group ( P  = 0.28), and the mean manifest refractive cylinder, −2.87 ± 1.09 D and −2.58 ± 0.85 D, respectively ( P  = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group ( P  = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively ( P  = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group ( P  = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups.    Conclusions  Both TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.    Trial registration    NCT03202485

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism