AIM: To determine the indications for penetrating keratoplasty in Malaysia and to compare the leading indications with recently published data from other countries. · METHODS: A retrospective review of the medical records of all patients who underwent penetrating keratoplasty at Medical Centre, University of Malaya, Kuala Lumpur, Malaysia over a period of fifteen years (1991/2005) was done. The gender, age, race of patients, eye operated, indication for surgery were noted from the records, and analyzed. · RESULTS: A total of 125 penetrating keratoplasties were performed in 105 patients (male 71 and female 34; Chinese 55, Indians 33, and Malays 17; unilateral 85 and bilateral 20) during the study period. The mean age of patients was 51.3 years (range 13-79 years). The indications for penetrating keratoplasty were pseudophakic bullous keratopathy (28.8%), corneal scar (20.0%), keratoconus (17.6%), regrafts (9.6%), corneal dystrophies (8.8%) and corneal perforations (7.2%). · CONCLUSION: Pseudophakic bullous keratopathy is the most common indication for penetrating keratoplasty in Malaysia. The three leading indications (pseudophakic bullous keratopathy, corneal scar and keratoconus) in our study are similar to many countries in the world, but they differ in the order of frequency from some countries.