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PURPOSE: . To examine changes in the transplanted human cornea over a period of one'­ year using confocal microscopy METHODS: Patient MC underwent penetrating keratoplasty (PK) for Fuchs' Endothelial Dystrophy. An in-vivo slit-scanning real-time confocal microscope (Tomey ConfoScan P4, Erlangen, Germany) fitted with an Achroplan 40X/0.75NA immersion objective was used to examine the central cornea of patient MC at X680 magnification. Confocal microscopy was carried out at 3, 5 and 13 months after surgery. Video images of all corneal layers were captured and analysed both quantitatively and qualitatively. RESULTS: The epithelial basal cell layer was not visible 3 months following surgery, but could be seen clearly after 5 months An acellular layer representing Bowman's layer was more clearly imaged at 13 months than at 3 and 5 months. Nerve fragments could be seen in Bowman's layer at 13 months. The clarity of the corneal stroma appeared to remain constant although keratocyte nuclei appeared to be. better defined at 13 months. The keratocyte density of the anterior and posterior stroma remained relatively constant at all visits. Folds were seen as dark bands in the stroma and appeared to be present towards the posterior stroma. The number of folds decreased with increasing time after the surgery. Endothelial cell density decreased in the 13 months following PK by 22%. CONCLUSIONS: This case report demonstrates the established decrease in ECD in the first year following transplantation. It also suggests that the keratocyte density remains stable. The clarity of all corneal layers increases with increasing time after surgery.