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To report the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK).A retrospective case series was conducted on 51 patients who underwent DSAEK 5 years ago. DSAEK was performed for Fuchs corneal dystrophy, pseudophakic or aphakic bullous keratopathy, or failed penetrating keratoplasty (PKP). Best spectacle–corrected visual acuity (BSCVA), endothelial cell counts (ECC), and current graft status were ascertained for the eyes included in the study. Episodes of rejection and need for repeat transplantation were also analyzed.Forty-seven of 51 eyes had clear grafts at the most recent postoperative visit. There were 4 graft failures treated with repeat DSAEK, and regrafts are also clear to date. One eye had an episode of rejection that was successfully treated with topical steroids.Long-term results of DSAEK were excellent. Grafts were clear despite lower than normal endothelial cell counts. To our knowledge, this is the longest running study of DSAEK outcomes to date.