Indications and surgical techniques for penetrating keratoplasties (PKs) were evaluated to determine present trends and suggest future directions for PK. Analyses were based on 3,941 PK cases, with questionnaires completed at the time of surgery by 638 surgeons receiving tissue through Tissue Banks International, Inc. between July 1, 1985, and December 31, 1988. The leading indications for PK were pseudophakic corneal edema (PCE) (23%), graft failure (17%), Fuchs' corneal dystrophy (13%), kerataconus (13%), keratitis/scar (12%), and aphakic corneal edema (10%). Indications for PK varied by age and sex. Anterior chamber (AC) lenses accounted for the majority (56%) of PCE cases. Penetrating keratoplasty for PCE occurred within 5 years of cataract surgery for 81% of patients with PC lenses and only 52% of patients with AC lenses. Intraocular lens exchange was performed in most AC and iris-fixed lens PCE cases (65% and 77%, respectively), but less frequently in PC lens cases (17%). A PC lens was placed in 29% of all PCE lens exchange cases. These data have confirmed and expanded observations from smaller studies about leading indications and surgical techniques for PK. Therefore, eye bank data may be useful in describing and monitoring future indications and trends for PK because they provide a broader base of information than that obtained through a single institution.