In recent years, endothelial keratoplasty has become increasingly popular in the management of endothelial pathologies of the cornea. This technique is primarily indicated in pseudophakic keratopathy and Fuchs dystrophy and significantly reduces known complications that occur after penetrating keratoplasty (i.e., major astigmatism, graft junction weakness, ocular surface diseases). Visual recovery is also more rapid. The endothelium is removed using a reverse hook or forceps and replaced by an endothelial graft that also includes a certain stromal thickness. The preparation of the donor graft can be automated by using a microkeratome or can be performed manually on artificial anterior chamber. Although automated dissection techniques have become the most popular approach, thin posterior graft can only be obtained using a manual dissection procedure. Several studies are currently underway to assess the possibility of reducing endothelial cell injury when preparing and inserting the graft. Progress in this specific field of research will greatly encourage future use of endothelial keratoplasty.