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To compare the outcome of penetrating keratoplasty performed by supervised cornea fellows and an experienced staff surgeon.Retrospective review of cases of penetrating keratoplasty performed over a 4-year period with corneal topography performed on a clear graft. Overall, 202 cases from 184 patients were included: 108 performed by an experienced staff surgeon and 94 cases by 9 cornea fellows. Charts were reviewed for topographic astigmatism, other topographic indices, refractive astigmatism and best-corrected visual acuity (BCVA), all recorded after removal of the 10-0 sutures while the 11-0 suture remained in place. Graft clarity was assessed at final follow-up.Mean postoperative topographic astigmatism was 4.60 ± 2.7 diopters in the fellow group and 4.08 ± 2.41 diopters in the staff group. The mean postoperative time at which corneal topography was obtained was 9.53 ± 4.4 months in the fellow group and 9.22 ± 4.6 months in the staff group. Mean refractive astigmatism was 3.77 ± 1.97 diopters (fellows) and 3.49 ± 1.93 diopters (staff). Mean surface asymmetry index (SAI) was 1.89 ± 1.42 (fellows) and 1.61 ± 1.08 (staff). Mean surface regularity index (SRI) was 1.43 ± 0.72 (fellows) and 1.45 ± 0.61 (staff). Mean BCVA was 0.49 logMAR (20/61) ± 4.3 lines (fellows) and 0.47 logMAR (20/59) ± 3.9 lines (staff). In the fellow group, 85 (90%) cases remained clear over a mean follow-up of 32 months and in the staff group 100 (93%) grafts remained clear over a mean follow-up of 38 months. Simple and multiple regression analyses indicated no difference between the 2 groups in all outcome measures.Properly supervised cornea fellows in training achieved favorable penetrating keratoplasty results that were comparable to those of an experienced staff surgeon.