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To assess the relationship of graft thickness (GT) with visual acuity in patients who have undergone Descemet stripping automated endothelial keratoplasty (DSAEK).We performed a retrospective chart review of all DSAEK patients who had anterior segment optical coherence tomography imaging. Donor tissue characteristics and clinical information were obtained from the eye bank and from the medical record, respectively. Patients with graft failure or with visually significant comorbidities were excluded for statistical analyses of the visual acuity.Sixty-four eyes of 52 patients with a mean follow-up of 27 ± 16 months were included in the study. The mean preoperative GT of 199 ± 45 μm (range, 106–303 μm) was higher than the postoperative GT of 165 ± 53 μm (range, 88–335μm) (P < 0.0001). There was a moderate correlation of preoperative GT with postoperative GT (r = 0.41; P =0.0009). Mean Snellen visual acuity was 20/28 at 1 year and 20/29 at the final visit (r = 0.80; P < 0.0001). There was a poor correlation of best-corrected visual acuity at the final visit with preoperative GT (r = 0.11; P = 0.57) or with postoperative GT (r = 0.26; P = 0.16). Multivariate linear regression analysis indicates no association of either postoperative GT or best-corrected visual acuity at the final visit with donor tissue endothelial cell density, death-to-preservation time, death-to-surgery time, donor age, patient age, or length of postoperative follow-up.GT decreased after transplantation; however, there was a poor correlation of visual acuity with preoperative or postoperative DSAEK GT.