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Although often curative, TPK carries a higher risk of endothelial rejection, reduced graft survival, and increased complications due to its open-sky approach. Lamellar keratoplasty, particularly deep anterior lamellar keratoplasty, has emerged as a promising surgical alternative in cases where the infection has spared the deeper corneal layers. Compared with full-thickness therapeutic keratoplasty, it offers advantages including improved graft survival, lower rejection rates and fewer postoperative complications. Nevertheless, recurrence may still occur in deep or extensive infections, and advanced cases with descemetocele, perforation, or limbal or scleral involvement often still require TPK. This article on TPK summarizes peer-reviewed literature from the past decade, incorporating recent advances in corneal surgery while placing the modern-day application of classically described techniques into perspective to strengthen surgical decision-making. Emphasis is placed on resistant pathogens, surgical indications, preoperative evaluation, anesthesia considerations, operative techniques, prognostic factors, and postoperative management strategies. 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