Purpose TO evaluate the efficacy and safety of a toric implantable Collamer lens (Visian TICL®) for correction of high postkeratoplasty ametropia in patients with keratoconus. Methods Seven eyes of 7 keratoconus patients postkeratoplasty (5 M, 2 F; mean age 34.1±5.9 years, range 28–44) unable to wear glasses or contact lenses were included in the study. A foldable phakic posterior chamber Collamer toric lens was injected through a standard 3.0-mm clear corneal temporal incision. Uncorrected distance visual acuity (UCDVA, logMAR), best-corrected distance visual acuity (BCDVA, logMAR), spherical refraction, cylindrical refraction, and refractive spherical equivalent (RSE) were measured preoperatively and postoperatively. Postoperative adverse events were recorded. Results The mean follow-up was 12.8±8.8 months (range 4–30). A significant (p<0.01) improvement was observed postoperatively in mean UCDVA (1.18±0.4 vs 0.2±0.1), spherical refraction (-5.89±3.43 vs 0.53±0.75), cylindrical refraction (-4.39±0.75 vs −1.74±0.84), and RSE (-8.09±3.77 vs −0.33±0.54). The BCDVA changes were not significant (0.09±0.11 vs 0.05±0.08). All patients gained ≥5 lines of UCDVA (average 7.6±1.9 lines). The number of patients with UCDVA ≥6/12 (0.3 logMAR) increased after surgery (0% vs 87.5%; p<0.01), while the number of patients with BCDVA ≥6/12 was unchanged (100% vs 100%; NS), with 0% (0/7) of patients losing ≥2 BCDVA lines. No complications were observed postoperatively. Conclusions Toric implantable Collamer lens was safe and effective in correcting postkeratoplasty myopia and astigmatism in keratoconus patients.