: Penetrating keratoplasty (PKP), in which all the layers of the cornea are removed and replaced by the tissues obtained from a donor, remains for long time as the surgical method of choice in treating diseased cornea when medical approach fails. Because of graft rejection following PKP and associated post-operative complications there has been a change toward another technique known as the deep anterior lamellar keratoplasty (DALK) in which healthy tissue are retained and removal process will be restricted to disease tissue only leading to less immunological rejection. the current study was planned and conducted in order to compare two groups of patients, PKP and DALK groups, in term of visual acuity, rate of rejection and intraocular pressure (IOP). This case reference study was based on reviewing the available records of patients who underwent keratoplasty during the period extending from January 2014 through December 2019 in a single private center owned and directed by the author of the current study. The records were searched for age of patients at time of presentation, their gender, indication of operation, best corrected visual acuity, signs of graft rejection and intraocular pressure (IOP). The inclusion was based on collecting information for at least one year comprising 5 visits; each visit is 2 to 3 months apart. During the first, second and third visits, there was significant difference in the rate of good visual acuity (best corrected visual acuity BCVA≥6/15) between PKP and DALK groups (P < 0.05); being higher in DALK group, 39.5 % versus 13.8 %, 42.1 % versus 20.7 % and 47.4 % versus 24.1 %, respectively. The rate of good visual acuity during the 4th and the 5th visits was also higher in DALK group in comparison with PKP group, 55.3 % versus 34.5 % and 68.4 % versus 41.4 %, respectively; however, the difference did not reach statistical significance as p-values were 0.057 and 0.073. In the 2nd, 3rd and 4th visits, there was no significant difference in the rate of rejection between both groups (P > 0.05); however, there was significant difference in the rate of rejection during the last visit (P = 0.046), being lower in the DALK group. there was no significant difference in mean IOP between PKP and DALK groups during all reviewed visits (P > 0.05). our study has shown that DALK is superior to PKP because of less rate of rejection and better visual acuity results with lack of significant difference in post-operative mean IOP.