The results of epikeratoplasty for keratoconus in ten patients with long-term follow-up (mean, 25 months; range, 19 to 31 months) vs ten patients with contemporaneous penetrating keratoplasty for keratoconus (mean, 33 months; range, three to 81 months) indicate a similar level of postoperative spectacle visual acuity (20/32 vs 20/27, respectively) and similar refractive and keratometric results. The healing period until achieving best corrected visual acuity averaged 12 months for epikeratoplasty vs three months for penetrating keratoplasty. Compared with penetrating keratoplasty, epikeratoplasty offers the advantages of maintaining an intact globe surgically and postoperatively in a young, active population, while avoiding potential immune rejection. The major disadvantages are a prolonged healing period and undefined limits in the extent of the cone that would define suitable candidates preoperatively.