Abstract： An 18-year-old male came to our hospital for surgery to correct his astigmatism.The patient complained of high astigmatism since childhood and no history of wearing glasses.Uncorrected distance visual acuity(UDVA):R:0.05,L:0.15.Subjective refraction:R:-4.00/-6.75×175→1.0-,L:+1.00/-11.00×175→0.8.External appearance:Narrow and elongated palpebral fissures.The slit lamp examination showed no obvious abnormality.The patient was diagnosed with high astigmatism,anisometropia and suspected keratoconus.Frame glasses and regular follow-ups were scheduled.One year later,the corneal curvature of both eyes increased compared to before,and transepithelial corneal cross-linking surgery was performed on both eyes.Two years later,the patient returned for a follow-up and requested surgical correction with a stable corneal curvature.It was decided to apply the innovative autologous astigmatism lenticule reshaping and rotation surgery for correction:firstly,femtosecond laser was used to create an astigmatic lenticule,then excimer laser was used to reshape it.Subsequently,the lens was rotated 90 degree and repositioned followed by the corneal flap attached to complete the surgery.The postoperative UDVA stabled at 0.8 from 1 month after surgery,and the best corrected visual acuity(BCVA)remained stable compared to the preoperative.The subjective refraction was R:0/-1.25×100=1.0,L:+1.50/-1.50×150=0.8.For patients with high astigmatism,it is necessary to conduct comprehensive examination and long-term follow-up to determine with the possibility of keratoconus and assess the risk of postoperative corneal ectasia.For those in doubt,transepithelial corneal cross-linking surgery can be attempted to stabilize the cornea.For ultra-high astigmatism that is difficult to correct with conventional surgical methods,under stable corneal conditions,autogenous astigmatism lenticule reshaping and rotation surgery can be attempted to achieve satisfactory visual effects.