Descemet membrane endothelial keratoplasty (DMEK) is associated with faster visual recovery, better visual quality, and a more physiological replacement of the diseased endothelium as compared with Descemet-stripping automated EK. The initial learning curve is surgically challenging, owing to difficulties faced during tissue handling of the thin Descemet-endothelium complex. In this video, we describe simple surgical tips and tricks to tackle various intraoperative challenges faced during graft insertion and attachment in the initial 100 cases. The use of intraoperative optical coherence tomography to assess correct graft orientation is highlighted in a spectrum of cases. Various methods to effectively open the DMEK scroll, manage a tight DMEK scroll and flip an inverted graft are highlighted. Surgical tips regarding effective anterior chamber manipulations to ensure correct graft orientation and attachment are provided, and optimal anatomical outcomes could be achieved in all cases.