In early stages of the disease, drops aimed at drying out the swollen cornea, can be used to improve the blurry vision in the morning. Even pressure lowering drugs can help clearing the cornea for a while. If the disease progresses or other treatments fail, surgery is the only way to improve vision. A few years ago, the whole corneas was replaced. Pioneering work by Dr. Gerrit Melles in the Netherlands led to the discovery that selective replacement of only the back layers of the cornea was possible through keyhole surgery. This is called “endothelial keratoplasty” and has revolutionized corneal surgery in the last years. Initially, we removed the endothelium and replaced it with the inner 20% of the donor cornea (DSAEK). Most corneal surgeons have now switched to offer “DMEK” – in which only the endothelial cells and their supporting membrane (2% of the donor cornea) is transplanted (DMEK). Replacing the diseased layer by exactly the same anatomic structure has further improved visual results and has helped to speed up healing times and to diminish rejection rates.