Descemet's stripping endothelial keratoplasty (DSEK) is a relatively new technique that is rapidly replacing full-thickness procedures for those patients needing corneal transplantation for endothelial dysfunction. Benefits of DSEK include a faster recovery, reduced astigmatism, fewer postoperative complications and retained structural integrity. This article reviews the surgical indications, technical considerations, outcomes and potential complications associated with the DSEK procedure. We also comment on our surgical experience, including the advantages and improved patient satisfaction with the DSEK procedure relative to older techniques.