PURPOSE: To evaluate the visual and refractive outcomes after toric intraocular lens (IOL) implantation in patients with high amounts of corneal astigmatism. SETTING: University Eye Clinic, Maastricht, The Netherlands; Oftalvist Centro Integral Ocular and Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. DESIGN: Cohort study. METHODS: This study comprised eyes with cataract and more than 2.25 diopters (D) of corneal astigmatism who had toric Acrysof SN60T6, SN60T7, SN60T8, or SN60T9 IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, visual potential index (ratio of postoperative UDVA to postoperative CDVA), residual refractive cylinder, IOL misalignment, and surgically induced astigmatism (SIA) were evaluated. RESULTS: The mean follow-up in this study of 67 eyes (45 patients) was 6.3 months. Postoperatively, the mean UDVA was 0.61 +/- 0.26 (SD) and the mean CDVA, 0.81 +/- 0.21. The UDVA of 20/40 was better in 83% of eyes and 20/30 or better in 50% of eyes. The mean visual potential index was 0.78. The residual refractive cylinder was less than 0.75 D in 62% of eyes and less than 1.00 D in 81% of eyes. The mean IOL misalignment was 3.2 +/- 2.8 degrees. The mean SIA was -0.40 +/- 0.60 D with a superior incision and -0.19 +/- 0.78 D with a temporal incision (P=.034). CONCLUSION: Implantation of the toric IOL during cataract surgery was effective and safe in correcting high amounts of corneal astigmatism.