Objective To investigate the clinical efficacy of ORK （optimized refractive keratectomy customized ablation manager） for myopia combined with medium and high astigmatism. Methods It was retrospective study. Thirty-four myopia patients forty-eight eyes combined with medium and high astigmatism （≥2.0 D） were treated with ORK by excimer laster treatment system of Esiris of Germany. Preoperative and postoperative tests included vision， dioptre， astigmatism and the axis of astigmatism. Data were analyzed using paired t test. Results After 6 months′ follow up，the results showed that uncorrected visual acurity （UVAC） was over 0.8 in 100% and 1.0 in 98% repectively. The postoperative UCVA better than preoperative best-corrected visual acuity （BCVA） was in 98%. There was no significant difference between UVAC and BCVA （t=-0.538， P＞0.05）. There were 40 eyes （83%） within 1.00 D of astigmatism. 15 eyes （31%） were within 0.5 D of astigmatism. The average residual astigmatism was 0.69±0.40 D. Astigmatic axial change within 5°. Conclusion It proved that the ORK is an effective and safety method to treat myopia combined with medium and high astigmatism.