Endothelial keratoplasty (EK) has now replaced penetrating keratoplasty (PK) as the standard of care for endothelial dysfunction. In this presentation, Dr. Mark Terry reviews the established benefits and indications for EK. He describes common complications, including dislocation, graft failure, pupillary block glaucoma, and eccentric donor trephination, and then methods for avoiding or mitigating these complications. Dr. Terry debunks several misconceptions about donor tissue, specifically that dislocation and failure rates are not in fact improved with a higher preoperative endothelial cell count, a broader donor disc, shorter storage time, or thinner grafts. Techniques, advantages, and disadvantages of Descemet-stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) are discussed briefly.