Seventy-two penetrating primary keratoplasties for herpes simplex keratitis performed from 1970 to 1993 were reviewed. Postoperative follow-up periods ranged from 6 months to 16 years with 2 years median. Epithelial herpetic recurrence occurred in 25% of the transplants the first year and in 44% during the first 2 years. Primary allograft rejection was observed in 29% of the grafts the first year and in 46% during the first 2 years. Preoperative inflammation was a risk factor for preservation of a clear cornea (p < 0.10). The degree of corneal vascularization prior to operation did not influence the survival of the grafts. The overall one-year survival rate of a clear graft was 84% and the 2-year survival rate was 67%. Prophylactic antiviral treatment is discussed.