In this video, the authors present 4 extreme cases of keratoplasty (KP) that were referred to their cornea unit. The first was a long-term 4-mm corneal perforation in which a protected penetrating KP was performed to avoid the complications of open-sky surgery. The second was a severe case of corneal neovascularization treated with a Krumeich ring in penetrating KP. The third consisted of peripheral recurrent melting from previous KP for which prior amniotic membrane (AM) and lamellar scleral grafts had failed, thus, peripheral lamellar and penetrating KP were performed. The fourth patient presented with recurrent pterygium associated with symblepharon after multiple interventions in which peripheral lamellar KP, symblepharon resection, and fornix reconstruction with AM transplantation were carried out.