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Purpose: To assess the safety and efficacy of implanting Artisan toric phakic intraocular lenses (PIOLs) (Ophtec BV, Groningen, The Netherlands) in eyes with high degrees of compound myopic, hyperopic, and mixed astigmatism., Methods: Twenty-five eyes (20 patients) presenting with high astigmatism were implanted with Artisan toric PIOLs and followed for 1 year. Group 1 included 8 eyes (myopic astigmatism), group 2 included 9 eyes (hyperopic astigmatism), and group 3 included 8 eyes (mixed astigmatism)., Results: In the myopic astigmatism group, 8 (100%) of 8 eyes had preoperative uncorrected visual acuity (UCVA) of < or = 20/50, and at 6-month follow-up, 5 (62.5%) of 8 eyes had UCVA of > or = 20/40 (P = .005). In this group, 75% of eyes were within +/- 1.00 diopter (D) of the intended correction. In the hyperopic astigmatism group, 8 (88.9%) of 9 eyes had preoperative UCVA of < or = 20/40, and at 6-month follow-up, 6 (66.6%) of 9 eyes had UCVA of > or = 20/32 (P = .199). Approximately 77.8% of eyes were within +/- 1.00 D of the intended correction. In the mixed astigmatism group, 8 (100%) of 8 eyes had preoperative UCVA of < or = 20/50, and at 6-month follow-up, 6 (87.5%) of 8 eyes had UCVA of > or = 20/40 (P = .007). In this group, 87.5% of eyes were within +/- 1.00 D of the intended correction. The safety index of the procedure was 1.6, 1.3, and 1.3 in the myopic, hyperopic, and mixed astigmatism groups, respectively. The efficacy index of the procedure was 1.2, 1.0, and 1.0 in the myopic, hyperopic, and mixed astigmatism groups, respectively., Conclusions: Artisan toric PIOLs are safe for the correction of high degrees of astigmatism associated with myopic or hyperopic spherical refractive defect.