Automated lamellar therapeutic keratoplasty using an automated microkeratome and artificial anterior chamber to obtain lamellar cuts of repeatable quality and thickness has completely changed lamellar corneal transplantation. The recent introduction of femtosecond laser for the creation of lamellar cuts has offered further opportunities. Its main principle is the use of ultrashort infrared laser pulses to cause intrastomal microdissection without ablation. The benefit of lamellar cornea surgery includes reduction of rejection rates, increased speed of rehabilitation, reduction of suture related problems, reduction of postoperative astigmatism and higher wound tensile strength. ALTK is simple, reversible, uses topical anesthetic drops that are instilled in the patient’s eyes, it is an extraocular surgery and it has reduced the risk of immunologic reaction. “The visual recovery time is very rapid and as the cut made by microkeratome is regular and homogenous there is less postoperative irregular astigmatism. Reduced interface haze and crisp vision, quick recovery and fast rehabilitation are definite motivating factors for corneal surgeons to adapt to these procedures”. “Epikeratophakia for keratoconus is a simple, reversible, extraocular surgery and has a reduce risk of immunologic reactions. It has a wide range of possible refractive corrections. The major complications of epikeratophakia are related to delay in epithelialization; whit a compromised epithelium patient are at risk of developing infections, and poor epithelialization can lead to melting of the tissue. Persistent refractive errors and infiltrates at the recipient-lenticule interface are other important issue. A rare complication is dehiscence of the graft. Persistent haze is another postoperative issue.”