The main indications for the latest techniques in corneal endothelial transplantation (DMEK) Posterior elastic lamellar corneal endothelial transplantation is indicated for corneal endothelial malfunction due to various internal eye surgeries, posterior polymorphic corneal dystrophy, congenital inherited endothelial dystrophy, Fuchs’ endothelial corneal dystrophy, iris-keratocorneal endothelial syndrome, large vesicular keratoconus with an IOL or aphakia, failed penetrating corneal transplants , failed corneal endothelial grafts, or endothelial corneal loss due to injury, surgery, or closure of the atrial angle. However, for first-time corneal endothelial transplantation surgeons, patients without anterior segment anomalies are the best indication for DMEK. Posterior elastic lamellar corneal endothelial transplantation has specific advantages: First, DMEK has a preferred surgical concept of transplanting only the posterior elastic lamellae with healthy endothelial cells, while preserving all the healthy tissue of the recipient cornea, which results in a postoperative anatomy that is more consistent with the physiology of the cornea, and, consequently, in a faster recovery of visual acuity. Secondly, the clear corneal tunnel incision used in DMEK effectively reduces postoperative astigmatism because the tissue becomes a curled film, making small incisions possible. Third, compared to DSEK, DMEK produces a more regular posterior corneal stromal surface, which reduces postoperative edema, and tissue healing response, and significantly reduces higher-order phase aberrations, resulting in better postoperative visual outcomes. Typically, DSEK patients achieve 0.5 or better vision without comorbidities, but rarely achieve 1.0 or better. DMEK, however, allows patients in the same condition to achieve 1.0 and above vision consistently. DMEK eliminates the donor corneal stroma, reducing the volume of donor tissue by 75-90% and significantly reducing the incidence of immune rejection. Another point is that for DSEK/DSAEK, the operator needs to use a corneal laminar knife and a femtosecond laser, whereas the graft for DMEK can be obtained directly from the corneoscleral limbus with a ring drill, without the need for high-end equipment. This is more suitable to be carried out and popularized in China and developing countries. In addition, DMEK is effective in combination with other procedures such as cataract surgery.RodrÃguez et al. believe that DMEK has the potential to be the most effective treatment for corneal endothelial lesions with its simple surgical procedure, lower requirements for surgical equipment and techniques, fewer postoperative complications, and faster vision recovery. So far, DMEK is the thinnest implant we can obtain and the new technique that maximizes the best visual outcome for patients under the same conditions.