AIM: To evaluate the visual acuity and endothelial cell density according to thethickness in Descemet''s stripping automated endothelial keratoplasty (DSAEK) one year after surgery.METHODS: DSAEK patients'' data were reviewed. Thirty-seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy (PBK) were included in this study. Graft thickness was measured with optical coherence tomography (OCT) 12mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick (>200 μm), medium-thick (150-200 μm) and thin (<150 μm). Best corrected visual acuity (BCVA), endothelial cells density (ECD) and complications were assessed and comparisons were done between groups.RESULTS:There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12mo, mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts (P=0.001). Thick graft group had 1637.44±88.19-mm², medium thick graft had 1764.50±34.28-mm² and thin graft group had 1845.30±65.62-mm² ECD at 12mo after the surgery. Thin graft group had better ECD at 12mo after surgery (P=0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes with medium-thick and thick grafts one year after surgery.