In this presentation from AAO 2016, Mark A. Terry, MD, discusses the role of Descemet's membrane endothelial keratoplasty (DMEK) as the primary procedure for endothelial replacement. Currently, DMEK carries very low rebubble and graft failure rates and is easily mastered by new surgeons. Dr. Terry highlights additional advantages of the procedure, including great visual outcomes, less postoperative steroids required compared with other transplants, and prepared eye-bank tissue that saves time and prevents upside-down grafts. However, DSAEK and PK remain the best options for some cases.