PURPOSE: To report our results using PRK combined with PTK to treat keratoconus. METHODS: Forty-one patients (70 eyes) underwent PRK+PTK with a Nidek EC-5000 excimer laser. PRK included spherical or cylindrical ablations, or both. PRK ablation zone diameter was 6.00 mm. PTK was performed with an ablation zone diameter of 8.00 mm and a transition zone of 9 mm. PTK ablation zone was decentered toward the cone apex, according to corneal topography. RESULTS: Refractive results: UCVA increased from 0.07 ± 0.003 to 0.76 ± 0.03 (69.2% of eyes had uncorrected visual acuity of 1.0); mean BSCVA increased from 0.70 ± 0.03 to 0.83 ± 0.04; myopia decreased from a mean 5.32 ± 0.62 D to 1.55 ± 0.30 D and astigmatism decreased from a mean 3.25 ± 0.53 D to 1.75 ± 0.25 D. Therapeutic results: Keratoconus progression was stopped in 91.43% of eyes with a mean follow-up of 3.5 years and maximum follow-up of 6 years. CONCLUSION: PRK+PTK with the Nidek EC-5000 excimer laser was an excellent option for patients with primary keratoconus. [J Refract Surg 2003;19(suppl):S250-S254]