Although endothelial keratoplasty (EK) is the procedure of choice for endothelial failure, there is still a role, albeit limited, for penetrating keratoplasty (PKP) in cases where EK is not possible (eg, full-thickness corneal scar). A major risk factor in PKP is the open sky, which leaves the patient vulnerable to extrusion of intraocular contents if there is positive vitreous pressure or even choroidal hemorrhage. We present a video of a “sandwich” technique for performing PKP that eliminates open sky exposure. This video will aim to give the following learning points: (1) Sandwich PKP is a useful technique in cases of increased posterior pressure and iris prolapse, as it limits open-sky time for the corneal surgeon. (2) Sandwich PKP reduces the risk of complications such as suprachoroidal hemorrhagic expulsion. (3) It is critical to ensure that the recipient cornea is completely dissected (aside from four cardinal sutures) to enable ease of removal when the donor corneal button is sutured.