Phakic Intraocular surgery has come a long way in the past 20 years, especially in the evolution of posterior chamber phakic intraocular lenses (PC PIOLs). Clinical trials worldwide are showing acceptable results concerning efficacy, predictability, stability, and safety. PC PIOLS are proving to be a promising option for patients with high and extreme ametropia who cannot benefit from conventional corneal refractive procedures.This article provides an in-depth examination of PC PIOLs, their origin and evolution, and the results of past and current clinical studies. Reports of historical importance and studies published since the 1990s in peer-reviewed journals, textbooks, and monthly eye magazines, as well as Food and Drug Administration preliminary clinical findings, are reviewed. Anterior chamber phakic intraocular lenses are mentioned briefly.