The safety and efficacy of topography-guided PRK (tPRK) treatments after Descemet-stripping automated endothelial keratoplasty (DSAEK) will be demonstrated in cases that underwent tPRK 8-18 months following DSAEK. Surgical planning, technique and postop management will be demonstrated, along with perioperative uncorrected and corrected distance visual acuity (UDVA, CDVA), refractive, keratometric, topography and tomography data by Scheimpflug and anterior segment OCT up to 120 months. Mean values changes: UDVA, from 20/50 to 20/26; CDVA, 20/30 to 20/16; no eyes lost lines of CDVA. All imaging data to include epithelial thickness map normality improved by month 3. tPRK after DSAEK appears to be safe and very effective in improving visual function. Therapeutic improvement of the scarred anterior corneal surface of the host may also enhance the refractive correction.