Endothelial keratoplasty (EK) has recently emerged as an alternative to penetrating keratoplasty (PK) for patients with endothelial diseases, including Fuchs' endothelial dystrophy, pseudophakic bullous keratopathy, and corneal graft failure. EK provides distinct advantages over PK, in that it is a less invasive procedure and leads to more rapid recovery of vision. Additionally, this procedure does not require long-term corneal sutures, eliminating problems with suture breakage, suture abscesses, astigmatism, and wound dehiscence. Disadvantages of EK include the need for specially prepared donor tissue and additional surgeon training or experience. In this review we discuss the history of EK, recent advances that have led to its widespread use, limits and complications of the procedure, and areas for future improvement.