Abstract Descemet stripping endothelial keratoplasty (DSEK) is one of the preferred surgical techniques for combatting endothelial disorders owing to its faster recovery, reduced rejection rates, and superior visual outcomes compared to penetrating keratoplasty. However, for beginner corneal surgeons, the steep learning curve and intra-operative technical challenges can be intimidating, especially while doing manual DSEK. This article aims to demystify DSEK by providing a comprehensive and practical approach tailored for early-career surgeons. The technique is broken down into logically sequenced, reproducible steps—from donor preparation and host bed creation to graft insertion, unfolding, and centration. Emphasis is placed on key decision points and intra-operative tips to avoid common pitfalls. Steps are discussed in practical detail to enhance surgical confidence and reproducibility. Also mentioned are key insights on patient selection, pre-operative planning, and post-operative care—all essential for achieving optimal outcomes and long-term graft survival. Corneal surgeons in training or just beginning their practice will be equipped with a simplified yet safe roadmap to initiate their DSEK journey, with particular attention to reducing endothelial cell loss and improving graft attachment rates. This structured yet practical approach is designed to encourage wider adoption of manual DSEK and empower surgeons to perform the procedure confidently.
Mohan et al. (Thu,) studied this question.