PURPOSE: To compare the visual and refractive results of femtosecond laser-assisted LASIK (FS-LASIK) with and without the adjuvant use of mitomycin C (MMC) to correct hyperopia. METHODS: A total of 152 consecutive hyperopic eyes were included in this retrospective, observational cohort study, comparing 76 eyes treated with FS-LASIK + MMC with 76 age-and refraction-matched eyes treated with FS-LASIK without MMC. Visual and refractive results were evaluated 1 day, 1 week, and 1, 3, 6, and 15 months postoperatively. RESULTS: Preoperative mean spherical equivalent was + 3.27 diopters (D) versus + 3.50 D in the MMC and no MMC groups, respectively (P >.05). Three months postoperatively, uncorrected distance visual acuity was significantly better in the MMC group (0.93 +/- 0.2) than in the no MMC group (0.87 +/- 0.2) (P =.01). The residual spherical equivalent was significantly lower in the MMC group (+ 0.18 +/- 0.40 D) than in the no MMC group (+ 0.42 +/- 0.50 D) (P =.01). Fifteen months postoperatively, including re-treated eyes, no significant differences were found in uncorrected distance visual acuity, corrected distance visual acuity, and residual refraction. Slightly better outcomes were found in the MMC group in terms of efficacy, safety, and predictability; however, these small differences were not statistically significant. The incidence of re-treatments during the 15-month follow-up was significantly lower in the MMC group than in the no MMC group (6.6% vs 10.5%, respectively) (P =.01). CONCLUSIONS: FS-LASIK with or without the intraoperative use of MMC is safe and effective to correct hyperopia. However, slightly better refractive outcomes and a lower incidence of re-treatments were observed when intraoperative MMC was used, at least in a 15-month follow-up.