After uncomplicated normal-risk penetrating keratoplasty (PKP) high and/or irregular corneal astigmatism and ametropia are among the major complications impairing the optical quality of the graft and binocular vision. These problems may be solved in part by nonmechanical corneal trephination in donor and recipient from the epithelial side using the 193-nm excimer laser along metal masks with eight “orientation teeth”. Applying appropriate combinations of pulse energy and spacing, successful creation of the flaps took between 31 and 90 seconds. Most flaps were easily removed manually, immediately after laser trephination. Thickness of different homogeneous flaps/beds with rectangular borders could be varied between 50 and 500 mm. Before removal, flaps were delineated by partly confluent gas bubbles (max. 2 mm long) with minute tissue bridges (typically 5 to 10 mm) in between. SEM displayed smooth cut surfaces and rectangular corners with minor remaining tissue bridges (~5 mm). By TEM, the cut edges were lined by a delicate, electron-dense layer (5 to 10 nm in width) and essentially normal adjacent collagen fibers without any evidence of thermal damage. Femtosecond laser technology seems to offer a promising approach towards minimally invasive posterior lamellar keratoplasty (femto-PLAK) via small tunnel incisions to avoid high postkeratoplasty astigmatism in corneal endothelial diseases. Further studies have to focus on the reproducibility of the flap thickness and the corneal endothelial changes in very thin lamellar grafts before we can proceed to clinical applications in patients.