AIM: To evaluate the safety and efficacy of transepithelial photorefractive keratectomy (t-PRK) with adjuvant mitomycin C (MMC) versus femtosecond laser assisted keratomileusis (Femto-LASIK) in correction of high myopia. METHODS: Prospective randomized comparative study including 156 eyes of 156 patients with high myopia and a spherical equivalent refraction (SER) <-6.00 D. They were divided randomly into two groups: Group A included 72 eyes treated with t-PRK with adjuvant MMC and Group B included 84 eyes treated with Femto-LASIK. Visual acuity, SER, corneal topography, pachymetry and keratometry were assessed for 12mo postoperatively. RESULTS: The preoperative mean SER was -8.86±1.81 and -9.25±1.70 D in t-PRK MMC group and Femto-LASIK respectively (P=0.99) which improved to -0.65±0.43 D and -0.69±0.50 D at 12mo follow up. Mean SER remained stable during the 12mo of follow-up, with no statistically significant difference between the two groups (P=0.64). In t-PRK MMC group, only six eyes needed retreatment after six months of follow up. And two eyes showed haze (one reversible haze grade 2, while the other had dense irreversible haze grade 4). CONCLUSION: t-PRK MMC provides safe and satisfactory visual outcomes and acceptable risk as Femto-LASIK in patients with high myopia.