Donor tissue preparation remains a critical step in endothelial keratoplasty technique. Since its introduction in 2008 the use of pre-cut grafts for Descemet stripping automated endothelial keratoplasty (DSAEK) has become increasingly popular. Pre-cut tissue enables additional quality control, not readily available in the operating theater, shortens operation time, eliminates intraoperative donor related complications, overcomes surgeon’s learning curve associated with valuable donor tissue loss and allows surgeons who do not have the necessary equipment to perform the procedure. Previous reports suggesting thinner grafts may result in better visual outcomes have driven surgeons to either try and harvest ultra-thin grafts themselves or request eye banks to do so for them. However, preparation of ultra-thin grafts is not without challenges. In the current session the literature on the safety and efficacy of precut tissue for (ultra-thin) DSAEK will be reviewed. The results of our in-vitro studies on thickness reproducibility and endothelial cell viability of ultrathin precut tissue for DSAEK, using an innovative microkeratome system, as well as our preliminary clinical experience with these grafts will be presented.