This patient has had many prior surgeries including cataract surgery, pars plana vitrectomy, Yamane fixated IOL, artificial iris implantation, and glaucoma tube shunt placement. My suspicion is that there was a very challenging cataract surgery that resulted in capsular bag damage/loss, iris damage, and lens fragments in the vitreous cavity. Then reconstructive surgery was done to perform a pars plana vitrectomy, then scleral fixated IOL, and artificial iris. Then when the intra-ocular pressure was not controlled, implantation of a glaucoma tube shunt. The patient now has PBK: pseudo-phakic bullous keratopathy with edge to edge corneal edema and endothelial failure. Our guest surgeon, Dr Jack Parker (who will be on the CataractCoach Podcast in the near future) performs a beautiful large diameter DMEK graft. Amazingly this procedure is very quick and efficient and only requires (in his hands) topical anesthesia and oral diazepam for sedation. At the end of the case filtered room air is placed in the anterior chamber and the patient does not require any special positioning.