High astigmatism is one of the most common and difficult problems, after penetrating keratoplasty, that can limit visual performance and decrease patient satisfaction after PK. Various methods have been tried to treat post-keratoplasty astigmatism and include laser ablations; another treatment option is the surgical implantation of a toric phakic intraocular lens; the advantage of this surgical techniques is the fact that the implantation requires no direct manipulation or ablation of donor cornea. The Artisan toric IOL has a convex-concave toric optic with a spherical and a spherocylindrical posterior surface, this particular type of toric lens is iris claw-fixated. The surgical techniques is generally the same as that used with standard Artisan refractive phakic IOLs. Toric IOL implantation after PK can result in decreased post-keratoplasty refractive astigmatism and ametropia; decreasing endothelial cell counts can occur and should be monitored carefully with anterior imaging systems; the primary goal of treating of astigmatism after PK is the correction of sufficient myopia and astigmatism in order to enable patients to wear spectacles or contact lenses.