Purpose. To present a case of a keratoconic patient who underwent epithelial removal with transepithelial phototherapeutic keratectomy (t-PTK) using a 213-nm solid-state laser system followed by corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) irradiation. Methods. Case report. Results. A twenty-four-year-old male with keratoconus underwent CXL treatment after epithelial removal with t-PTK using a solid-state laser system. No intra- or early postoperative complications were found. One month postoperatively, uncorrected visual acuity (UCVA) improved from 20/63 to 20/32 while best spectacle- corrected visual acuity (BSCVA) improved from 20/40 to 20/25. Corneal topography revealed a significant improvement which remained stable during the six-month followup period. Conclusions. Epithelial removal with t-PTK before CXL could improve patient's visual outcome.