In this paper, we examine the 193 nm excimer laser's efficacy and safety in treating myopic astigmatism. The VISX Twenty/Twenty excimer laser uses aperture elements to effect astigmatic photorefractive keratectomy. In 70 patients with six months follow-up, the average postoperative sphere was -0.14 and the average postoperative cylinder was -0.54. Seventy-one percent of these patients had uncorrected visual acuity of 20/40 or better at six months. In 12 patients with one year follow-up, the average postoperative sphere was -0.05 and the average postoperative cylinder was -0.59. Eighty-three percent of these patients had uncorrected acuities of 20/40 or better; none had a clinically significant loss of best corrected acuity. This investigation demonstrates that the excimer laser can be used to treat myopic astigmatism successfully.