One hundred thirty-two penetrating keratoplasties (91 patients) for herpetic keratoplasty were reviewed retrospectively. The overall survival rate of clear keratoplasties to two years was 64% and to five years was 62%. The significant prognostic factors were preoperative ocular inflammatory status and degree of corneal vascularization. The two-year survival rate of a clear keratoplasty was 69% where eyes were inflamed at the time of surgery, compared with 44% in actively inflamed eyes. Allograft rejection, the major cause of a clouded herpetic keratoplasty, increased in frequency with increasing corneal vascularization. Antiviral cover was not used with routine postoperative steroids or with steroid intensive therapy for rejection. Epithelial herpetic recurrences occurred in 32% of eyes undergoing allograft rejection within four months of initiation of treatment for rejection. This is compared with otherwise uncomplicated keratoplasties where the epithelial recurrence rate was 6% at four months, on high-dose postoperative corticosteroid therapy without antiviral cover.