A clear graft but high degree of postkeratoplasty astigmatism was found to be hazardous to the patient’s visual outcome. For good visual outcome it is important to consider all the steps during keratoplasty so as to avoid decentration of the trephine, tilt of the trephine, distortion of the button edge, the different suture materials and techniques etc. To reduce the degree of astigmatism thus different techniques are employed in surgery such as temporal approach surgery, using laser trephine etc. Any residual astigmatism is dealt with using contact lenses, incisional refractive surgery and laser, which gives tremendous results with the least complications.