Endothelial dysfunction caused by pseudophakic bullous keratopathy and Fuchs’ endothelial dystrophy is the leading cause of corneal visual loss in the United States. Penetrating keratoplasty (PKP) with implantation of an iris-fixated posterior chamber intraocular lens (PC IOL) is the standard procedure for treating pseudophakic bullous keratopathy with an anterior chamber intraocular lens (AC IOL). Deep lamellar endothelial keratoplasty (DLEK) is a good alternative to PKP for endothelial replacement. In cases of aphakic or pseudophakic (AC IOL) bullous keratopathy, placement of a scleral-fixated PC IOL or replacement of the AC IOL with a scleral-fixated PC IOL may be performed by using the superior incision of DLEK together with small superior and inferior scleral flaps. The basic surgical procedure of DLEK through a 9.0 mm superior limbal incision as described by Terry and Ousley is carried out. This is combined with an automated anterior vitrectomy and scleral-fixated PC IOL as described by Helal et al.