目的 观察分析经皮准分子激光屈光性角膜切削术（SPT-Trans PRK）的3种个性化手术设计方案对近视散光的术后视觉质量和高阶像差的影响，为更合理地选择个性化设计方案提供依据。 方法 96例（96眼）近视散光患者，按照3种个性化设计方案以及常规模式分组并手术。其中个性化1组行消彗差模式24眼；个性化2组行minimize消球差模式24眼；个性化3组行minimize无球差模式24眼；对照组行常规模式24眼。分析各组术前和术后3个月的最佳较正视力、角膜前表面的球差、慧差、总高阶像差、手术设计软件中个性化与常规方案的角膜切削厚度差值。 结果 （1）个性化组的术后视力情况均优于对照组（P < 0.05）；（2）个性化2组切削更少的角膜组织（P < 0.01）；（3）球差：个性化2组低于个性化1、3组（P < 0.01），对照组高于个性化1、2、3组（P < 0.05）；（4）彗差：对照组术后升高明显（P < 0.01），个性化1、2、3组两两比较差异无统计学意义（P > 0.05）；（5）总高阶像差：各个组术后较术前均有明显升高（P < 0.01）。个性化2组低于个性化1、3组，差异有统计学意义（P < 0.05）。对照组高于个性化2、3组，差异有统计学意义（P < 0.05）。 结论 对于近视散光，SPT-Trans PRK采取个性化手术方案中的minimize消球差模式，优化术后高阶像差的效果更明显，术后视觉质量更好，同时更节省角膜组织。

Objective To investigate and analyze the impact of three personalized surgical design schemes for SPT trans PRK on postoperative visual quality and higher-order aberrations in individuals with myopic astigmatism， aiming to provide a foundation for more rational selection of personalized design schemes. Methods The 96 cases （96 eyes） with myopic astigmatism were divided into three groups based on three personalized design schemes and a conventional mode. Specifically， 24 eyes were assigned to the personalized group 1， which focused on coma elimination； another 24 eyes belonged to personalized group 2， where the aim was to minimize spherical aberration elimination； and the remaining 24 eyes were further categorized into personalized group 3 based on a model that aimed at minimizing spherical aberration. Additionally， there were also 24 eyes in the control group treated using the conventional mode. The study compared and analyzed various parameters including best corrected visual acuity， spherical aberration， coma， total higher-order aberration of the anterior corneal surface， as well as differences in corneal ablation thickness between personalized and conventional schemes within the surgical design software. Results （1） The postoperative visual acuity of the personalized group was significantly superior to that of the control group （P < 0.05）； （2） Among the personalized groups， Group 2 exhibited a reduced amount of corneal tissue ablation compared to other groups （P < 0.01）； （3） Group 2 demonstrated lower values than the other groups after surgery （P < 0.05）. （4） Coma： The control group showed a significantly higher level of coma compared to preoperative measurements （P < 0.01）. No significant differences were observed between Groups 1， 2， and 3 after surgery （P > 0.05）. （5） Total higher-order aberrations： All groups experienced a significant increase in total higher-order aberrations following surgery （P < 0.01）. Group 2 exhibited lower values than the other groups postoperatively （P < 0.05）. Conclusion For myopic astigmatism， SPT trans PRK incorporates the personalized surgical scheme with a focus on minimizing spherical aberration elimination mode， resulting in enhanced optimization of postoperative high-order aberration and improved visual quality， while preserving corneal tissue.