In this presentation from the 2012 Annual Meeting, Dr. Gerrit Melles discusses the ongoing development of endothelial keratoplasty from deep lamellar (DLEK) to Descemet stripping (automated, DSEK/DSAEK) to Descemet membrane (DMEK/DMAEK), and possibly Descemet membrane endothelial transfer DMET. DSEK/DSAEK is currently the most widely used technique. Better clinical outcomes may be obtained with DMEK, but this procedure is perceived as surgically more challenging. Dr. Melles concludes with initiatives to lower barriers to widespread use of DMEK.