Purpose:To evaluate postoperative astigmatism with regard to incision-induced astigmatism and deviation in axial alignment with the use of preoperative limbalmarking with the Javal keratometer(Haag Streit,Bern,Switzerland) in eyes implantedwith the Artisan toric phakic intraocular lens(IOL) (Ophtec,Groningen,The Netherlands) .Design:Prospective nonrandomized trial.Participants:Fifty-four eyes of 33 patients with myopia(mean,-9.67 diopters [D]) and astigmatism(mean,-3.44 D) .Intervention:The enclavation site was marked on the limbus using the Javal keratometer.The Artisan toric phakic IOL was implanted according to the axis marked on the limbus.Followup was a minimum of 6 months.Main Outcome Measures:Safety index,efficacy index,predictability,safety,and vector analysis of total refractive correction were determined.The effects of axis misalignment and incision-induced astigmatism on the final refractive error were evaluated.Results:At 6 months after surgery,the safety index was 1.29± 0.29 and the efficacy index was 1.04± 0.35.Mean spherical equivalent subjective refraction reduced from-11.39± 4.86 D before surgery to-0.38± 0.57 D at 6 months.Sixty-seven percent of eyes were within 0.50 D of attempted refraction and 89% were within 1.00 D.Mean preoperative cylinder was 2.92± 1.60 D at 91.4°.At 6 months,the mean cylinder was 0.28± 0.54 D at 174.3°.No eyes lost 2 or more lines of best-corrected visual acuity at 6 months.Eighty-three percent of eyes achieved uncorrected visual acuity of 20/40 and 28% achieved 20/20.Vector analysis of total surgically induced astigmatism revealed a mean cylindrical change of 3.21± 1.71 D.Average axis misalignment was 0.37± 5.34°.The mean incision-induced astigmatism was 0.74± 0.61 D at 0.2°.Conclusions:Implantation of the myopic toric IOL leads to safe,efficacious,and predictable results.The level of unpredictability caused by minor axis IOL misalignment has minimal effects on the residual refractive error.The procedure of axis alignment with the Javal keratometer seems to be an accurate method of marking the eye for toric IOL implantation.Incision-induced astigmatism can result in an overcorrection of the cylinder.A systematic undercorrection of-0.50 D for attempted cylindrical outcome could result in an achieved correction closer to emmetropia. Purpose: To evaluate postoperative astigmatism with regard to incision-induced astigmatism and deviation in axial alignment with the use of preoperative limbalmarking with the Javal keratometer (Haag Streit, Bern, Switzerland) in eyes implanted with the Artisan toric phakic intraocular lens (IOL) (Ophtec , Groningen, The Netherlands). Design: Prospective nonrandomized trial. Participants: Fifty-four eyes of 33 patients with myopia (mean, -9.67 diopters [D]) and astigmatism (mean, -3.44 D). Intervention: The enclavation site was marked on the limbus using the Javal keratometer. The Artisan toric phakic IOL was implanted according to the axis marked on the limbus. Vollowup was a minimum of 6 months. Main Outcome Measures: Safety index, efficacy index, predictability, safety, and vector analysis of total refractive correction were determined. These effects of axis misalignment and incision-induced astigmatism on the final refractive error were both. Results: At 6 months after surgery, the safety index was 1.29 ± 0 .29 and the efficacy index was 1.04 ± 0.35 .Mean spherical equivalent subjective refraction reduced from -11.39 ± 4.86 D before surgery to-0.38 ± 0.57 D at 6 months. Sixty-seven percent of eyes were within 0.50 D of attempted refraction and 89 % were within 1.00 D. Man preoperative cylinder was 2.92 ± 1.60 D at 91.4 ° .At 6 months, the mean cylinder was 0.28 ± 0.54 D at 174.3 ° .No eyes lost 2 or more lines of best-corrected visual acuity at 6 months .Eighty-three percent of eyes achieved uncorrected visual acuity of 20/40 and 28% achieved 20 / 20. Vector analysis of total surgically induced astigmatism revealed a mean cylindrical change of 3.21 ± 1.71 D. Average axis misalignment was 0.37 ± 5.34 °. The mean incision-induced astigmatism was 0.74 ± 0.61 D at 0.2 ° .Conclusions: Implantation of the myopic toric IOL leads to safe, efficacious, and predictable results. The level of unpredictability caused by minor axis IOL misalignment has minimal effects on the residual refractive error.The procedure of ax is alignmentwith the Javal keratometer seems to be an accurate method of marking the eye for toric IOL implantation.Incision-induced astigmatism can result in an overcorrection of the cylinder. A systematic undercorrection of-0.50 D for attempted cylindrical outcome could result in an achieved correction true closer to emmetropia.