Will penetrating keratoplasty become obsolete?

The development of technologies for performing lamellar cuts of the cornea constitutes a major breakthrough in corneal grafting, since it can bypass the well-identified limits of penetrative keratoplasty such as intraocular pressure elevation and graft rejection with nonreversible edema, which are major but unpredictable complications of penetrative keratoplasty. A surgical procedure that could exchange only pathologic tissue layers might be able to eliminate all these adverse events and provide faster visual recovery with better visual performance. However, certain indications for penetrative graft will certainly remain, benefiting from the considerable progress in surgical technique with the advent of femtosecond laser and the the control of immunomodulation. This article develops arguments to answer the three following questions: Why should we replace penetrative keratoplasty? Why will this procedure survive? How can we improve it?