The aim of this study was to evaluate the long-term safety and efficacy of photorefractive keratectomy (PRK) for patients with myopia and thin corneas. In this retrospective case series, we included 74 eyes of 38 patients with myopia and central corneal thickness (CCT) < 550 µm who underwent PRK and had a mean postoperative follow-up period of four years. The following factors were evaluated: CCT, refraction, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), ablation depth, safety and efficacy indices (i.e., the ratio of the mean postoperative BCVA to the mean preoperative BCVA, and the ratio of the mean postoperative UCVA to mean preoperative the BCVA, respectively), and evidence of corneal ectasia (based on Orbscan topography images).The patients were aged 20 - 46 years (mean ±SD age, 28.18± 6.82 years). The mean ± SD pre- and postoperative CCTwas485.92 ± 9.27 µm and 434.84 ± 20.48 µm, respectively. The mean ± SD pre- and postoperative myopia was -2.77 D ± 1.51 and -0.24 ± 0.39 D, respectively, and the mean ± SD pre- and postoperative astigmatism was -0.82 D ± 0.99 and -0.37 ± 0.37 D, respectively. The mean pre- and postoperative BCVA and postoperative UCVA was 0.011 ± 0.03 Logarithm of the Minimum Angle of Resolution (log MAR), 0.003 ± 0.01 log MAR, and 0.054 ± 0.09 log MAR, respectively. The mean ± SD ablation depth, safety index and efficacy index was 54.34 ± 16.28 µm, 0.02 ± 0.12, and 0.11 ± 0.50, respectively. Regarding the postoperative corneal clarity, 72 eyes (97.3%) had a clear cornea (grade 0) and the remaining two eyes of one patient (2.70%) had a trace haze (grade 1). There was no evidence of corneal ectasia on any of the Orbscan topography images. Thus, among patients with myopia and thin corneas (<500 µm), PRK seems to be acceptable in terms of both safety and efficacy 4 years after surgery, based on the stability of postoperative refraction, visual acuity, and topographic outcomes, and outcomes based on the safety and efficacy indexes.