We report the results obtained in two groups of 30 eyes surgically treated for keratoconus. The eyes in the first group underwent epikeratoplasty, and those in the second group, penetrating keratoplasty. All eyes had sutures removed and a follow-up period ranging from 3 to 6 years. In the epikeratoplasty group, mean postoperative uncorrected visual acuity was 20/52 +/- 0.25; spectacle corrected, 20/23 +/- 0.18; and contact lens corrected, 20/21 +/- 0.17. In the penetrating keratoplasty group, mean postoperative uncorrected visual acuity was 20/63 +/- 0.23; spectacle corrected, 20/22 +/- 0.11; and contact lens corrected, 20/20.5 +/- 0.07. In the epikeratoplasty group, astigmatism (2.18 +/- 1.48) and astigmatism reduction (-4.16 +/- 2.98) were comparable to the penetrating keratoplasty group (astigmatism; 3.16 +/- 1.43 and astigmatism reduction; -4.2 +/- 2.56). Among the advantages offered by epikeratoplasty were both the absence of immunologic complications and reduction of operative risk. Penetrating keratoplasty provided patients with higher reduction of the myopic defect and earlier improvement in both visual acuity and contrast sensitivity.