Overall success rates are relatively lower in Descemet-stripping endothelial keratoplasty (DSEK) in cases of failed penetrating keratoplasty (PK). Donor unfolding and centration is a problem, and donor dislocation is higher due to a prominent inner ridge at the host-graft junction. This video demonstrates a few tips and tricks for improving outcomes in such cases, emphasizing that donor size is the most important prognostic factor for success.