Purpose To compare the visual outcomes between PRK-MMC and phakic IOL in patients with more than 8 diopter (D) of myopia. Methods This comparative study was performed on 23 eyes under treatment with Artiflex (group A) and 23 eyes under treatment with PRK-MMC (group B). Artiflex phakic IOL (Ophtec BV) was used in group A, and the VISX STAR S4 Excimer Laser (Abbott) was used for PRK-MMC in group B. Results The safety index was 1.11 ± 0.23 and 1.05 ± 0.25 (P ¼ 0.100) and the efficacy index was 1.02 ± 0.11 and 0.98 ± 0.10 (P ¼ 0.266) in group A and B, respectively. At 1 year after surgery, the manifest refraction spherical equivalent was À 0.17±1.18 and À 0.25±0.18 D in group A and B, respectively (P ¼ 0.471). Mesopic CS showed no significant difference between the two groups in any spatial frequency. Total coma was 0.24 ± 0.17 and 0.67 ± 0.40 mm (Po0.001), spherical aberration was À 0.11±0.11 and 0.41±0.18 mm (Po0.001), and RMS HOA T was 0.50±0.20 and 0.96±0.45 mm (Po0.001) in group A and B, respectively. Conclusion Phakic IOL implantation was better than PRK-MMC in the correction of high myopia in terms of visual quality, but the two methods had no difference with regard to visual acuity. Therefore, PRK-MMC can be used when the anterior chamber depth is a limiting factor in the implantation of phakic IOLs.