A 75-year-old man was first seen with a history of aphakic bullous keratopathy in his left eye. He had undergone extracapsular cataract extraction in 1973. In his left eye, the best-corrected visual acuity was counting fingers, and the intraocular pressure (IOP) was 18 mm Hg. At the end of uneventful DSEK, the anterior chamber was completely filled with filtered air. The patient was left face up for 1 hour, and afterward 50% of the air was evacuated. One drop of 1% cyclopentolate was instilled to prevent pupillary block. On the first postoperative day, the disc was attached, 40% air was present, and the IOP was 16 mm Hg. Blood was present at the interface peripherally (Figure 1A). Anterior chamber optical coherence tomography (Visante; Carl Zeiss Meditec, Dublin, California) revealed a well-apposed corneal disc with increased signal peripherally, secondary to the interface blood (Figure 1B and C). Corneal edema progressively resolved, and at postoperative month 1 the visual acuity was 20/100.