Descemet’s stripping automated endothelial keratoplasty (DSAEK) has surpassed penetrating keratoplasty (PK) as the preferred treatment method for patients with corneal endothelial dysfunction.

Nevertheless, PK remains the gold standard treatment for patients with visually significant corneal scarring.

In this report, the authors present a patient with long-standing corneal edema and extensive subepithelial fibrosis that showed restoration of corneal clarity following DSAEK alone.

DSAEK could be considered as an alternative therapeutic option in cases of advanced bullous keratopathy with anterior stromal fibrosis, especially in patients with low postoperative visual potential or a contraindication for PK.