Penetrating keratoplasty is the most common method of corneal graft no matter which pathology is present. The surgical procedure is easy but unnecessary substitution of healthy recipient endothelium in diseases affecting only the anterior layers exposes the patient to the risk of immunologic rejection. Lamellar keratoplasty was the first procedure described. It has become less popular because it is technically difficult to perform and often has poor visual results due to imperfect lamellar dissection. Recent advances in surgical techniques enable us to manage these difficulties and lamellar keratoplasty may well become the first choice of treatment for most stromal diseases.