Purpose. To identify current indications and trends in indications for penetrating keratoplasty and associated procedures. Methods. Retrospective chart review of all patients who underwent penetrating keratoplasty at Wills Eye Hospital from January 1, 1990 to December 31, 2000. Results. A total of 1.529 corneal transplants ere performed during this 5-year period. The leading indications for penetrating keratoplast ere pseudophakic bullous keratopathy (PBK) in 410 (27.2%) cases. followed by regraft in 276 (18.1%). keratoconus in 230 (15.4%). and Fuchs endothelial dystrophy in 233 (15.2%) cases. Of the 416 PBK cases, 271 (65.1%) were associated with posterior chamber intraocular lenses (PC IOLs) 141 (33.9%) with anterior chamber intraocular lenses (AC IOLs). and four (1%) with iris-fixated lenses. Of these 141 AC IOLs. 107 (75.9%) were closed-loop and 34 (24.1%) were open-loop. Of the 416 PBK cases, in 281 (67.5%) cases, the IOL was not exchanged: in 127 (30.5%) cases, the IOL was exchanged: in six (1.5%) cases, the IOL was repositioned and in two (0.5%) cases, the IOL was removed at the time of surgery. Of the 271 PC IOLs, 248 (91.5%) were not exchanged and 19 (7.1%) were exchanged. Of the 141 AC IOLs. 33 (23.4%) were not exchanged and 104 (73.7%) were exchanged (p = 0.001). Conclusions. Pseudophakic bullous keratopathy remains the leading indication for corneal transplantation at our institution followed by regraft. The percent. age of PBK cases associated with PC IOLs has increased significantly, whereas the percentage associated with AC IOLs has decreased. The frequency of regraft has also increased significantly.