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A 43-year-old male patient with a history of cataract surgery in childhood presented with bullous keratopathy and visual loss. DSAEK with intraocular lens fixation to sclera and pars plana vitrectomy was performed with intraoperative OCT. Macular OCT were performed in the trans-surgical procedure and the adhesion of the graft was corroborated in a trans-surgical manner.