Background: Keratoconus is a non-inflammatory condition where the cornea assumes a conical shape because of thinning and protrusion of the corneal stroma. The corneal thinning induces irregular astigmatism, myopia, and corneal protrusion, leading to mild to marked impairment in the quality of vision. Symptoms are highly variable and, in part, depend on the stage of progression of the disorder. Objective: To compare refractive and topographic outcomes between cross-linking (CXL) and corneal stromal puncture in stiffening the cornea and halt the progression of Keratoconus. Patients and Methods: This randomized controlled study included 19 patients (30 eyes) with keratoconus. They were not presenting with any eye disease and had never undergone eye surgery. The total number of subjects meeting the inclusion and exclusion criteria. They were divided into 2 groups, group (A) 9 patient: 15 eyes received cross-linking and group (B) 10 patient: 15 eyes received corneal puncture. All examination, investigation and the procedure were done at El Sayed Galal Hospital and Nour al Hyaa eye Hospital, Cairo. Results: The results showed significant improvement in postoperative value of UCVA, BCVA, than its preoperative value. In addition, a statistically significant decrease of postoperative K1 in both group than its preoperative value while there was a statistically significant increase of K2 postoperative value compared to preoperative value in puncture group, K2 showed significant decease postoperative in CXL group. There was significant increase in corneal thickness postoperatively compared to preoperative values in puncture group, corneal thickness showed significant decrease postoperatively in CXL group. Comparing both groups, there was significant improvement in postoperative UCVA, postoperative BCVA  in puncture group than in CXL group. On the other hand, there was a significant decrease in mean of postoperative corneal thickness in CXL group than puncture group. Conclusion: Overall, the results of this study continue to support the efficacy of CXL in progressive keratoconus and explored new modality of its treatment by anterior stromal puncture (ASP), with an improvement in UCVA, and BCVA 3 months after operation.