Keratoplasty following healed Herpes simplex viral (HSV) keratitis presents sizeable challenges at various stages, namely diagnosis, decision between medical and surgical treatment, preoperative assessment, intraoperative management, and postoperative care. This chapter details an overview of the key considerations in such cases, detailing both common and atypical features of HSV keratitis and their impact on surgical decision-making. It discusses the clinical examination, relevant investigations, indications for keratoplasty, and the intraoperative challenges that may arise, along with strategies to manage them effectively. Additionally, it outlines a structured approach to preoperative and postoperative care for high-risk grafts, emphasizing the importance of careful planning and execution to improve outcomes. By addressing these aspects, it aims to provide a comprehensive guide for corneal transplantation in patients with healed HSV keratitis.