Descemet-stripping automated endothelial keratoplasty (DSAEK) is an effective technique for managing endothelial failure post penetrating keratoplasty (PK). Relative contraindication exists for patients with high astigmatism resulting from the PK. This video demonstrates a 2-step technique: DSAEK followed by full-thickness relaxing incisions through the original PK wound performed as early as 1 month post-DSAEK. This technique helps restore clarity of the PK and reduce overall high astigmatism, leading to much faster visual rehabilitation than would be expected after repeat PK.