To compare the outcomes of a toric Implantable Collamer Lens (ICL) and a spherical Implantable Collamer Lens combined with astigmatic keratotomy (AK) in the correction of high myopic astigmatism.

Inclusion Criteria:

• age ranged from 18 to 40 years,
• myopia greater than -8.00 diopters (D), and refractive cylinder in the range of 1.50D to 5.50D,
• for the patients who were planned to undergo AK+ICL implantation, the axial difference between the corneal astigmatism and the manifest refractive astigmatism was less than 10 degree,
• a stable refractive error during the previous 2 years,
• anterior chamber depth more than 2.8 mm,
• endothelial cell density (ECD) more than 2500 cells/mm2, and
• scotopic pupillary diameter less than 7 mm.

Exclusion Criteria:

• subjects had significant irregular astigmatism, corneal pathological changes, glaucoma, ocular inflammation, or previous ocular trauma or surgery.