Penetrating keratoplasty is at present the accepted mode of treatment for patients with corneal endothelial damage resulting in corneal oedema. Where the corneal endothelium remains healthy, such as in keratoconus, corneal stromal dystrophies, and stromal scarring, the case for penetrating keratoplasty becomes unclear, and the debate as when to perform lamellar keratoplasty or penetrating keratoplasty continues.

The techniques of corneal grafting were first reported in the ophthalmic literature in 1824 by Reisinger,1 with experiments in rabbits. Kissam seems to be the first to have operated on humans using a pig cornea as the donor, but with little success. Von Hipple, in 1877–8, was the first to show an improvement in vision using his standardised technique2 which forms the basis of modern corneal transplantation. Zirm3 in 1906 is credited for the first corneal transplant to retain a moderate degree of transparency. Castroviejo gives a detailed review of the literature in his paper.4

Since then much work has gone into perfecting …