Over the 50 years, penetrating keratoplasty (PKP) has progressed from a rare procedure with marginal success to one of the most common and most successful tissue transplants. We review the changing indications for PKP between 1994 and 1998. In decreasing order, the six most common indications were: pseudophakic corneal edema, regraft, unspecified scar, unspecified ulcer, keratoconus, and Fuchs endothelial dystrophy.