To evaluate the efficacy, predictability, safety, stability, and complications of the Artiflex toric iris-fixated phakic intraocular lens (pIOL) for myopic astigmatism.Private practice surgery centers, Valencia and Terrassa, Spain.Cohort study.At 12 months, refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, complications, pIOL misalignment, and endothelial cell count (ECC) were evaluated. Indices of success and misalignment were calculated using vector analysis.The study enrolled 42 eyes in 25 patients aged 21 to 39 years. The mean spherical equivalent decreased from -8.85 diopters (D) ± 2.71 (SD) to -0.37 ± 0.46 D, with 66.7% of the eyes within ± 0.50 D. The mean cylinder power decreased from -2.90 D (range -1.50 to -5.00 D) to -0.39 D (range 0.00 to -1.50 D); refraction was highly stable. All eyes achieved a decimal UDVA of 0.5 or better and a CDVA of 0.8 or better. A gain of 1 line or more of CDVA was found in 69.1% of eyes. The mean clinical pIOL misalignment was 2.6 ± 1.8 degrees; 1 eye (2.4%) required surgical repositioning of the pIOL. The mean ECC decrease was 9.3% ± 1.8%; iris pigment precipitates were observed in 16.7% of eyes. Vector analysis showed excellent mean indices of success for overall (0.94 ± 0.04), spherical (0.96 ± 0.05), and astigmatic (0.95 ± 0.16) corrections; the mean angle of error was 1.8 ± 2.7 degrees.Implantation of the toric pIOL was effective, predictable, safe, and stable for the correction of myopic astigmatism.No author has a financial or proprietary interest in any material or method mentioned.