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The purpose is to present the complex management of a 76yo monocular lady with severe PBK and advanced Glaucoma. The Ahmed tube was plugged with a revised 3-0 nylon suture, prior to performing DSAEK. 2 days later the plug was removed. CDVA improved from 20/200 to 20/60, IOP remained controlled in low teens mmHg, with 1 years follow-up. A novel temporary plug technique was implemented with effective DSAEK graft and without valve compromise.