In an attempt to minimize postoperative astigmatism while retaining the advantages of implanting intraocular lenses with large optics, sutureless phacoemulsification with implantation of a 7-mm polymethyl methacrylate intraocular lens was performed through a modified scleral tunnel in 100 consecutive patients. Visual and keratometric results, as well as complications, were recorded during a follow-up period of 12 months. Average uncorrected visual acuity improved from 20/153 before surgery to 20/66 as early as 1 week after surgery. Average best corrected visual acuity improved from 20/86 before surgery to 20/39 as early as 1 week after surgery. No significant changes in visual acuity were recorded thereafter. The absolute value of keratometric astigmatism was not increased significantly at any postoperative examination time. The induced cylinder shifted from 1.26 diopters x 74.40 degrees at 1 week to 1.22 D x 1.50 degrees at 1 month after surgery, without further relevant changes thereafter. Mean (+/- SD) endothelial cell loss was 7.2% +/- 6.1% at 1 month and 12.2% +/- 5.4% at 6 months after surgery. Corneal thickness was not increased significantly at any postoperative examination time. Implantation of intraocular lenses with large optics through a scleral tunnel allows quick visual rehabilitation as well as early stability of refraction.