A 30-year-old white male with keratoconus had uneventful radial keratotomy in his right eye. Although a good initial response was obtained with total correction of myopia and astigmatism, by 18 months postoperatively the entire result had regressed and the patient demonstrated reformation of the cone and regression to high myopia. Scarring occurred in the three inferior cuts overlying the cone. Cuts on the horizontal axis, and superiorly (above the cone), had a normal appearance with normal wound healing. Because of the nature of the wound healing overlying the portion of the cornea affected by the keratoconus and because of the total regression of effect, radial keratotomy in patients with keratoconus does not appear to be an effective modality.