AIM To compare visual, surgical and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus (KC) patients. METHODS This study was conducted on 41 eyes of 41 Egyptian patients having advanced keratoconus. 22 eyes peformed PK and 19 performed DALK. All surgeries were carried out between August 2017 and September 2018. Preoperative and postoperative mean logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), spherical equivalent (SE) and corneal topography with pachymetry, K readings and Q value were evaluated. Results were recorded preoperative, at 6 months and one year postoperative. All surgeries were performed under regional (retrobulbar) or general anesthesia. RESULTS The mean age of the PK group was 30±16 years and the DALK group was 24±12 years. Preoperatively there was no significant difference in the logMAR BCVA, SE, pachymetry, K reading and Q value between the PK (2; -12.88; 287±101µ; 70.4±8.9D; -1.68) and DALK (1.6; -14.75; 328±62µ; 69.5±9.9D; -2.04) groups. Six months postoperative there was no significant difference in the logMAR BCVA, SE, pachymetry, K reading and Q value between the PK (0.6; +0.63; 525±50µ; 40.8±3.5D; -0.89) and DALK (0.7; +0.5; 529±33µ; 39.3±3.2D; 0.12) groups. One-year after surgery there was no significant difference in the logMAR BCVA, SE, pachymetry, K reading and Q value between the PK (0.5; -1.5; 526±60µ; 43.5±1.8D; -0.265) and DALK (0.4; -1.25; 521±31µ; 43.6±1.6D; -0.16) groups. CONCLUSION There were no significant visual, refractive nor topographic differences between KC patients undergoing PK and DALK.