OBJECTIVE To report histologic and ultrastructural findings of endothelial keratoplasty (EK) performed without Descemet's membrane stripping. METHODS Clinical techniques, histology, and transmission electron microscopy. RESULTS A 55-year-old woman was referred to us, after 2 unsuccessful penetrating keratoplasties (PKs), for pseudophakic bullous keratopathy. An 8.0-mm EK without Descemet's membrane stripping was performed, and clarity was restored to the failed penetrating regraft. A year later, the lamellar graft failed, and a third PK was performed for intractable corneal edema. Light microscopy of a semi-thin section of the trephined corneal button showed both the recipient's and the donor's Descemet's membrane, the well-preserved structure of the full-thickness graft, and marked edema of the adherent stromal carrier of the endothelial transplant. The host endothelium was absent at the interface, and the donor endothelium was atrophic. Electron microscopy revealed regularity and even spacing of collagen fibrils as well as quiet keratocytes on both sides of Descemet's membrane at PK-EK interface. CONCLUSIONS These findings suggest a lack of proliferation and hypercellular scarring, and offer further support to the already proven merits of EK.