It is well recognized that lamellar keratoplasty (LKP) has distinct advantages over penetrating keratoplasty (PKP). They include: Less intraocular complications such as endophthal­mitis, glaucoma, synechia formation, or injury to lens and vitreous, No risk of endothelial rejection, No need for long-term immunosuppression, which decreases the risk of infection, glaucoma and cataract, Superior wound strength and Less rigid criteria for donor corneal tissue selection. It is intriguing to know whether DLK provides same visual function compared with PKP. Sugita and Kondo reported in their retrospective analysis of 120 eyes undergoing DLK that mean corrected visual acuity improved from 0.09 to 0.6, and 71 eyes (62.8%) achieved corrected visual acuity of 0.5 or better. The results seem comparable to that of PKP. Another study to compare DLK and PKP was recently made in 48 eyes (24 eyes in each group). The authors reported that DLK group showed better visual acuity, higher rate of excellent clear grafts, less astigmatism, and more endothelial density. Comparison of DLK and PKP was also reported recently in eyes with keratoconus. The authors concluded that the visual function was comparable to each other. In summary, through a randomized, prospective comparison of DLK and PKP, found that DLK was superior to PKP in its safety against postoperative complications such as continuous decrease of endothelium or increases in intraocular pressure. According to our experience, DLK should be strongly recommended for high-risk cases such as eyes with corneal neovascularization. Comparison of PKP, LKP, and DLK is summarized in Table of this chapter.