DSAEK (Descemet stripping automated endothelial keratoplasty) is the main technique that is used in endothelial keratoplasty, where only the inner layer of the diseased cornea is replaced. The transplant is around 80-100 micrometer thick (compared to 10-20 microns in DMEK). This technique is used for a longer time then the newer DMEK surgery and is possible in most “complicated” cases (e.g. after glaucoma surgery). The diseased endothelial layer is excised and the transplant inserted in the anterior chamber. The transplant is centered and fixed with the help of an air bubble. All entry sites have to be sutured for 6 weeks. Especially in “complicated eyes”, the transplant can dislocate and has to be re-attached by an air bubble (Re-Bubbling). Within months after surgery, the vision will improve, but in certain cases, this can take longer.