Corneal transplants are the oldest, most common, and arguably the most successful form of solid tissue transplantation in the world. Since the first full-thickness corneal transplant was performed in 1905 by Eduard Zirm, penetrating keratoplasties (PKs) have been performed to provide a clear, optically functional visual pathway to improve vision, provide tectonic support for an eye, alleviate pain from corneal decompensation, and eliminate an infection in danger of spreading intraocularly. Corneal disease processes requiring transplantation may involve either the anterior cornea (e.g. scars, ectasias) or the posterior cornea (e.g. bullous keratopathy, endothelial dystrophies). In the past 10 years, a new and evolving alternate technique, known as Descemet stripping with endothelial keratoplasty (DSEK), has come about in which only the diseased portion of the posterior cornea is replaced by healthy posterior donor tissue. Important advantages of DSEK over PK are that the host cornea remains structurally intact and more resistant to injury, intra-operative and post-operative suture management issues are non-existent, and concerns about late wound dehiscence after suture removal are virtually absent. Furthermore, the risk of expulsive intra-operative suprachoroidal hemorrhage is minimized because the wound is small and can be closed quickly. Of importance to the patient are the rapid visual recovery, minimal induced astigmatism, and relative safety of topical anesthesia. This article will provide a brief overview of DSEK, an elegant technique for selective replacement of dysfunctional corneal endothelium that is constantly evolving and rapidly revolutionizing corneal transplantation.