The creation of an artificial anterior chamber (AAC) is a major milestone in the field of corneal surgery. This introduction of the AAC is changing the surgical landscape of corneal transplantation to a more favorable, and evolving field of lamellar corneal surgery. The pre-AAC era dealt with utilizing whole globes or corneoscleral button that was wrapped tightly around a glass orbital implant for the lamellar graft dissection. Issues during this era included difficulties in obtaining whole globes, stabilization of the whole globe for lamellar dissection, and less than optimal instrumentation. AAC was first described by Ward and Nesburn in 1976. They described a way to trephine the donor cornea from the anterior surface when the donor corneal-scleral tissue was mounted on an instrument that formed a seal around the scleral rim of the excised donor cornea, allowing the endothelium to be supported physically by the liquid storage medium. Hence, the AAC protected the donor endothelial cells from damage as if they were still in the intact globe. Although it was thought to provide better donor-recipient match for full-thickness penetrating keratoplasty (PKP), since both the donor and the recipient corneas were trephined from the anterior corneal surface with the same diameter trephine, the use of such an AAC extended across boundaries from PKP to lamellar keratoplasty (LKP). Since the initial description, various modifications and improvements in the AAC have been made giving ophthalmic surgeons the ability to trephine to any desired donor corneal depth. AAC may be utilized for both manual lamellar dissection, or automated lamellar dissection of the donor cornea using a microkeratome and the Moria automated lamellar therapeutic keratoplasty (ALTK) system. This chapter provides an introduction to the various AACs that are currently available in the United States at the time of this writing.