Purpose: To evaluate the indications for penetrating keratoplasty (PKP) and associated procedures in the Eye and ENT Hospital, Fudan University, Shanghai, People’s Republic of China, an eye center in East China and to compare our results with those from previous studies. Methods: We retrospectively studied the charts of cases who had received PKP in the hospital from 1994 to 2003. The recorded data covered age, sex, and preoperative clinical diagnoses of PKP, and surgical procedures in some cases. Results: A total of 229 cases received PKP during that period. The number of surgical cases increased dramatically in the last 3 years (2001-2003). The leading indication for PKP was corneal scar (55.9%), which included 44 (19.2%) cases of corneal scar after viral keratitis and 30 (13.1%) cases of corneal scar after chemical/thermal burn. Other indications, in order of decreasing frequency, were bullous keratopathy (12.2%), acute necrotizing/ulcerative keratitis (12.2%), regraft (10.5%), keratoconus (5.7%), and non-Fuchs’corneal dystrophies (3.8%). Combined procedures were performed on 22 cases. The most three common indications for PKP, corneal scar, bullous keratopathy, acute necrotizing/ulcerative keratitis, showed an increasing frequency in the period of the last 3 years. Conclusion: The leading indication for PKP was corneal scar, which differed from the conclusion offered by the developed areas in the world, where bullous keratopathy or keratoconus was the case. A similar result was also found in reports from India and Taiwan. Purpose: To evaluate the indications for penetrating keratoplasty (PKP) and associated procedures in the Eye and ENT Hospital, Fudan University, Shanghai, People’s Republic of China, an eye center in East China and to compare our results with those from previous studies. Methods : We retrospectively studied the charts of cases who had had PKP in the hospital from 1994 to 2003. The recorded data covered age, sex, and preoperative clinical diagnoses of PKP, and surgical procedures in some cases. Results: A total of 229 cases received The number of surgical cases increased dramatically in the last 3 years (2001-2003). The leading indication for PKP was corneal scar (55.9%), which included 44 (19.2%) cases of corneal scar after viral keratitis Other indications, in order of decreasing frequency, were bullous keratopathy (12.2%), acute necrotizing / ulcerative keratitis (12.2%), regraft (10.5%), ke The most three common indications for PKP, corneal scar, bullous keratopathy, acute necrotizing / ulcerative keratitis, showed an increasing frequency (5.7%), and non-Fuchs’corneal dystrophies in the period of the last 3 years. Conclusion: The leading indication for PKP was corneal scar, which differed from the ending offered in the developing areas in the world, where bullous keratopathy or keratoconus was the case. A similar result was also found in reports from India and Taiwan.