Abstract.An autokeratoplasty was performed on the left eye of a 64‐year‐old female, with the graft transferred from the contralateral, blind eye. The endothelial morphology and thickness of the central cornea were studied pre‐operatively and yearly for 6 years after surgery. The endothelial cell density decreased rapidly during the first 2 years post‐operatively (55.5%), after which cell loss occurred at a considerably slower rate (about 2% of the pre‐operative cell density per year). During the observation period, the coefficient of variation in cell size stayed relatively constant (approximately 0.3). When the corneal thickness returned to normal 2 months after surgery, the endothelium showed a significant decrease in the percentage of hexagonal cells (15.0%). Between 2 months and 2 years post‐operatively, the percentage of hexagonal cells gradually returned to normal. These endothelial changes noted are remarkably similar to those previously seen in homografts, suggesting that cell damage due to immunologic reactions may not be a major factor in long‐term endothelial changes after