Penetrating keratoplasty is the most commonly performed surgical procedure for ectatic corneas, but it is associated with complications including graft rejection, induced astigmatism, and complications of intraocular surgery such as glaucoma, cataract formation, retinal detachment, cystoid macular edema, endophthalmitis, and expulsive hemorrhage. To avoid these complications, new methods such as lamellar keratoplasty (LKP) and intrastromal corneal ring segments (Intacs; Micro-Thin Prescription Inserts; Addition Technologies, Fremont, California) have evolved. LKP has the advantages of being extraocular and reversible if tissue complications occur. Another advantage includes the ability to replace only selected areas of diseased corneal tissue with healthy donor tissue. LKP results, however, may be limited by vision-reducing graft-host interface problems and the technical nature of the surgical procedure.