A systematic review and meta-analysis compared Descemet membrane endothelial keratoplasty (DMEK) with ultrathin DSAEK in patients with Fuchs endothelial dystrophy and bullous keratopathy. The comparison is clinically relevant because ultrathin grafts aim to narrow the visual-performance gap between traditional DSAEK and DMEK while retaining some of the handling advantages of a thicker endothelial graft. The evidence base evaluated visual acuity, endothelial cell density, and postoperative complications, particularly graft detachment and rebubbling. For surgeons, the decision is therefore not simply a question of choosing the thinnest possible graft. DMEK can offer excellent optical outcomes but may demand greater surgical expertise, while ultrathin DSAEK can provide a practical compromise in selected eyes. Patient anatomy, availability of donor tissue, surgeon experience, and the anticipated need for repeat manipulation should all be considered. The paper is especially relevant to wet-lab training because it highlights how graft thickness and tissue characteristics influence handling, unfolding, positioning, and postoperative behavior. A technically successful operation should ultimately be judged by the balance between visual rehabilitation, endothelial survival, and manageable postoperative risk.