During the four-and-a-half year period from January 1982 to June 1986, 511 penetrating keratoplasty specimens were submitted to the Pathology Department of The Royal Victorian Eye and Ear Hospital. Seventy per cent were from patients of the RVEEH and the remainder were submitted from outside the Hospital. The cases were classified both clinically and pathologically. The most frequent diagnosis was keratoconus, followed by scarring, regrafts, bullous keratopathy, acute or chronic ulceration, corneal dystrophies and a small miscellaneous group. Post-herpetic scarring was the most common cause of scarring. Bullous keratopathy was usually aphakic in origin in 1982, but after 1983 pseudophakic bullous keratopathy (PBK) was the most common cause of bullous keratopathy. Acute ulceration was usually bacterial in origin, not infrequently with hypopyon.