This chapter presents discussion on eye bank preparation of pre-Descemet’s endothelial keratoplasty (PDEK) grafts. While DMEK strips only Descemet’s membrane and endothelium from recipient stroma, the proposed advantage of PDEK lies in the preservation of the pre-Descemet’s layer. The big bubble technique has enabled the eye bank community to obtain a graft that potentially combines the advantages of younger donor tissue with the better visual outcomes of DMEK. Studies of eye bank-prepared DMEK tissues report an estimated endothelial cell loss of between 5% and 15%. The few studies in the literature on PDEK suggest that endothelial cell loss in PDEK tissue preparation is no worse than what has been observed in DMEK preparation. Variations in technique may affect endothelial cell loss.