Abstract
<br>An accurately sized Phakic Intra-Ocular lens (PIOL) helps achieve adequate vault which in turn also provides for rotational stability. Toric PIOL implantation was done for a case with bilateral myopic astigmatism. Both eyes had similar spherical equivalent and ocular biometric parameters; thus, same sized PIOLs were implanted. Right eye post-operative course was uneventful but left eye repeated rotation was noted. An inadvertently placed smaller sized PIOL in left eye could explain rotation. Re-evaluation confirmed similar ocular and PIOL parameters in both eyes, but a shallow vault (444 μ) in left eye compared to right (602 μ). Post PIOL extraction, measurement confirmed the left PIOL size to be lesser (11.61 mm) than the expected size (12.75 mm).<br>
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