Penetrating keratoplasty has been the gold standard for the surgical treatment of corneal endothelial pathologies, but tremendous progress has been made in recent years in improving the technology of posterior lamellar keratoplasty techniques such as Descemet's stripping automated endothelial keratoplasty (DSAEK). This progress is shown by a literature review using PubMed sources and our own clinical and experimental data. Posterior lamellar keratoplasty using a microkeratome is a reliable surgical technique for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy. Visual rehabilitation is faster with lamellar compared with penetrating keratoplasty, but final visual acuity seems to be a bit reduced. Posterior lamellar keratoplasty techniques such as DSAEK may replace penetrating keratoplasty as the gold standard for treating a large proportion of corneal endothelial pathologies.