OBJECTIVES: To assess risks and benefits associated with AcrySof® Cachet™, other marketed phakic intraocular lenses (PIOLs) in Europe, and laser refractive surgery (RS) in patients with high myopia (HM).  METHODS: MEDLINE, Embase, and Cochrane databases were searched for randomised controlled trials and observational studies conducted in HM patients. Two reviewers undertook data extraction followed by reconciliation of included studies. Meta-analysis was performed to combine comparative data; weighted means were calculated for single arm studies. The quality of single arm studies was assessed using Downs and Black checklist (score ≥12: excellent quality). RESULTS: Of 1853 abstracts screened, 51 studies (23 comparative, 28 single arm studies) were included. Results were statistically significant in favour (OR, 95% CI) of PIOLs compared to RS for manifest refractive spherical equivalent (MRSE) within ±0.50D (3.42, 1.19–9.90), gain of ≥1 lines of best spectacles corrected visual acuity (BSCVA) (5.28, 1.26-21.97), and fewer secondary refractive procedures (0.18, 0.10–0.33). Mean quality index score was 15.04. Baseline characteristics including myopia severity and anterior chamber depth were comparable across studies. AcrySof® Cachet™ showed favourable efficacy for uncorrected distance visual acuity of 20/20 in 46.2% eyes at 3 years post-operative (Artisan and Visian had 40.8% and 31.0% eyes respectively). Percentage of eyes needing spectacles (criteria: MRSE not within ±0.50D) were 43.45%, 17.19%, and 6.14% for Visian, Artisan, and AcrySof® Cachet™ respectively. For safety, the loss of ≥1 lines of BSCVA was 0.56% in AcrySof® Cachet™ and 2.25%, 13.16% for Artisan and Visian respectively. Annualized post 6 month endothelial cell loss (0.41%) was within the expected rate of natural loss (0.6%±0.5%). CONCLUSIONS: PIOLs were associated with proven favourable efficacy and safety compared to RS. Amongst PIOLs, within the first 3 years AcrySof® Cachet™ has shown favourable efficacy and safety. Comparative trials are required to confirm the robustness of results.