case_images: PMC11007553_01
case_images: Right eye - penetrating keratoplasty at 1-month mark (personal photo archive - Dr. Alina Gheorghe)
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case_images: F1
case_images: The patient reported some higher-order aberrations after surgery, most likely due to the corneal surface irregularities typical in penetrating keratoplasty patients (Fig. 1). 
case_images: After cataract surgery, before DMEK. A. Corneal haze and subepithelial bullae; B. Beaten bronze aspect (personal photo archive of Dr. Alina Gheorghe)
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case_images: F2
case_images: Despite the success of the cataract surgery, the improvement in visual acuity was not significant; biomicroscopy performed one month later showed further corneal decompensation with central corneal haze, epithelial bullae, and a more pronounced beaten bronze aspect centrally (Fig. 2).
case_images: Endothelial graft preparation. A. Inserting the cannula in the predescemetic zone; B. Endothelial graft hydrodissection using trypan blue; C. Endothelial graft in double scroll configuration loaded in the glass cannula. Surgery: D. Descemetorhexis; E. Endothelial graft in double scroll configuration, inserted in the anterior chamber; F. Bubble placement after graft unscrolling and centration (personal photo archive of Dr. Alina Gheorghe)
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case_images: F3
case_images: Intraoperatively, good centration and graft attachment was achieved (Fig. 3).
case_images: Above - one day after DMEK, the endothelial graft is attached, and the air bubble is still present in the anterior chamber; below - AS-OCT showing increased central corneal thickness one day after DMEK (personal photo archive of Dr. Alina Gheorghe)
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case_images: F4
case_images: One day postoperatively, graft attachment was confirmed using AS-OCT and slit lamp exam (Fig. 4).
case_images: Left eye, 6 months post DMEK surgery (personal photo archive - Dr. Alina Gheorghe)
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case_images: F5
case_images: The endothelial graft remained attached (Fig. 5). 