Nishino T, et al. - Researchers retrospectively reviewed total keratoplasty procedures (penetrating keratoplasty [PK], deep anterior lamellar keratoplasty, anterior lamellar keratoplasty, Descemet’s stripping automated endothelial keratoplasty [DSAEK], and Descemet’s membrane endothelial keratoplasty) conducted over a 16-year period (2003–2018) at a tertiary referral hospital in Japan to observe trends in surgical procedures and causal diseases. During the 16-year period, a total of 801 keratoplasty procedures were conducted for 595 patients. At a tertiary referral hospital in Japan, the distribution of keratoplasty procedures and underlying diseases has changed significantly over 16 years. The PK procedure has decreased significantly, and the DSAEK procedure has increased significantly. The use of PK for BK reduced significantly. However, PK remains a viable choice for the treatment of other recalcitrant corneal diseases.