1：Experimental Design and Method Selection:

This prospective, consecutive, interventional series examined 25 eyes of 25 patients who underwent FS-DSEK for Fuchs endothelial dystrophy and bullous keratopathy. The pre-cut endothelial graft thickness (CET) was 150 lm. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), donor CET, recipient corneal stromal thickness (CST) and ECD were assessed at 1 week and 1, 2, 3 and 6 months postoperatively.

2：Sample Selection and Data Sources:

A total of 25 subjects who were diagnosed with Fuchs endothelial dystrophy or bullous keratopathy and underwent monocular FS-DSEK therapy, performed by the same surgeon, were enrolled from November 2014 to September 2016 at the Shanghai Eye, Ear, Nose and Throat Hospital.

3：List of Experimental Equipment and Materials:

Zeiss Visumax Keratoplasty system, Optisol GS (Chiron Ophthalmics, Irvine, CA, USA), CellCheck CLDK-148 (Konan Medical, Irvine, CA, USA), Visante OCT (Carl Zeiss Meditec Inc., Dublin, California, USA), Heidelberg Retina Tomograph III Rostock Corneal Module confocal microscope 1.3.3.0 (Heidelberg Engineering GmBH, Dossenheim, Germany).

4：0 (Heidelberg Engineering GmBH, Dossenheim, Germany). Experimental Procedures and Operational Workflow:

4. Experimental Procedures and Operational Workflow: The surgeon first made a 3–4 mm clear corneal incision and marked for removal the Descemet’s membrane from the central 7.75 mm diameter using a Price-Sinskey hook (ASICO, Westmont, IL). The recipient’s Descemet’s membrane and dysfunctional endothelium were then stripped. The graft was then rolled, with the endothelial surface inside, and inserted into the anterior chamber. The graft spread out automatically, as a result of tension, and a small air bubble was injected to fill the anterior chamber 100% to compress the graft for 10 min.

5：75 mm diameter using a Price-Sinskey hook (ASICO, Westmont, IL). The recipient’s Descemet’s membrane and dysfunctional endothelium were then stripped. The graft was then rolled, with the endothelial surface inside, and inserted into the anterior chamber. The graft spread out automatically, as a result of tension, and a small air bubble was injected to fill the anterior chamber 100% to compress the graft for 10 min. Data Analysis Methods:

5. Data Analysis Methods: Normality of the data was determined using the Shapiro–Wilk test. A one sample t test was used to analyze differences between endothelial graft thickness averages and the pre-cut baseline. Time-related changes among different follow-up time points were analyzed by one-way analysis of variance (ANOVA) and the least significant difference (LSD) test. Missing data were analyzed using the last observation carried forward. Correlations were examined using the Spearman correlation test.