Price MO, et al. - In this retrospective analysis, researchers examined a total of 754 consecutive Descemet membrane endothelial keratoplasty (DMEK) cases performed by 2 experienced surgeons to treat Fuchs dystrophy, to examine if graft orientation during insertion influences DMEK outcomes. They compared four groups with respect to outcomes. In group 1, one surgeon always inserted the tissue scrolled endothelium outward. Endothelium-outward scroll configuration (group 2), endothelium-inward trifold configuration (group 3), and trifold configuration with concurrent use of an anterior chamber maintainer (group 4) were the 3 methods that were tested by the other surgeon. They reported similar outcomes were provided by endothelium-out and endothelium-in (trifold) insertion methods with DMEK. The findings suggest that the choice is a matter of surgeon preference.