Penetrating keratoplasty (PK) was the primary corneal transplant technique for decades. But with the advent of various endothelial keratoplasty (EK) procedures and deep anterior lamellar keratoplasty (DALK), the role of PK has declined. In this presentation from Cornea Subspecialty Day, Dr. Chris Rapuano describes cases in which PK is still preferred to a more selective keratoplasty technique. Penetrating keratoplasty has several advantages: it is simpler than other keratoplasty procedures, allows easy access to the intraocular structures, and replaces the entire thickness of the cornea. Its main indication is for significant combined stromal and endothelial pathologies. Eyes with both Fuchs dystrophy and keratoconus, for example, and some eyes with bullous keratopathy are best treated with PK.