Management of myopic astigmatism with phakic intraocular lens implantation.

A 48-year-old woman presented with a manifest refraction of -9.25 -2.25 x 98 that resulted in a best corrected visual acuity (BCVA) of 20/20(-2) in the right eye. She was contact lens intolerant but was not a good candidate for laser in situ keratomileusis because of a thin cornea. A phakic posterior chamber intraocular lens (IOL) with a toric optic was implanted with no operative complications. One day after surgery, the uncorrected visual acuity (UCVA) was 20/15. Five months postoperatively, the UCVA in the operated eye was 20/15 with a manifest refraction of +0.25 -0.25 x 60 and a BCVA of 20/15. No changes to the crystalline lens or anterior lens capsule were seen. This is the first report of implantation of a toric phakic IOL in North America.