OBJECTIVE To measure changes in keratocyte density up to five years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). METHODS Prospective, nonrandomized clinical trial. METHODS Eighteen eyes of 12 patients received PRK to correct a mean refractive error of -3.73 +/- 1.30 diopters, and 17 eyes of 11 patients received LASIK to correct a mean refractive error of -6.56 +/- 2.44 diopters. Corneas were examined by using confocal microscopy before and six months, one year, two years, three years, and five years after the procedures. Keratocyte densities were determined in five stromal layers in PRK patients and in six stromal layers in LASIK patients. Differences between preoperative and postoperative cell densities were compared by using paired t tests with Bonferroni correction for five comparisons. RESULTS After PRK, keratocyte density in the anterior stroma decreased by 40%, 42%, 45%, and 47% at six months, two years, three years, and five years, respectively (P < .001). At five years, keratocyte density decreased by 20% to 24% in the posterior stroma (P < .05). After LASIK, keratocyte density in the stromal flap decreased by 22% at six months (P < .02) and 37% at five years (P < .001). Keratocyte density in the anterior retroablation zone decreased by 18% (P < .001) at one year and 42% (P < .001) at five years. At five years, keratocyte density decreased by 19% to 22% (P < .05) in the posterior stroma. CONCLUSIONS Keratocyte density decreases for at least five years in the anterior stroma after PRK and in the stromal flap and the retroablation zone after LASIK.