A series of 86 penetrating keratoplasties for keratoconus were analyzed. The surgery, using an 8.2 mm donor cornea into an 8.0 mm recipient opening, was performed over the period January 1983 to January 1986 by one surgeon. The donor cornea was secured by two opposing continuous sutures, placed at full corneal thickness under surgical keratometry control. Both sutures were removed at an average 30 weeks after surgery. The mean postoperative sutures-out astigmatism was 5.4 diopters (range 0-19.0 diopters) and following secondary astigmatism surgery in 17 eyes, the mean group astigmatism was 4.3 diopters (range 0-10.5 diopters). Although graft reaction occurred in 11.6% of cases it was cleared medically and did not affect final vision results. One month after suture removal, with spectacle correction, 45.5% of the primary group saw 20/20, 90.7% 20/30 or better, and 97.7% 20/40 or better. Comparing these results with recently published data on epikeratophakia for the treatment of keratoconus, it is evident that penetrating keratoplasty offers these usually young patients a better chance for recovery of useful industrial acuity.