PURPOSE: To determine whether Descemet stripping automated endothelial keratoplasty (DSAEK) donor cornea graft thickness impacts measurements of best spectacle-corrected visual acuity (BSCVA), refractive error and intraocular pressure (IOP). DESIGN: Retrospective chart review in a tertiary care center at Duke University Eye Center. METHODS: We studied 460 eyes that had undergone DSAEK surgery. They were segregated into three groups based on the thickness of the donor graft: <100 μm (n = 67 eyes); 100-150 μm (n = 316 eyes); and >150 μm (n = 77 eyes). The three graft-thickness groups were assessed at about 6 months postoperatively for measurement of BSCVA, spherical equivalent, and IOP. RESULTS: Baseline demographics were similar in the three groups. All groups experienced significant improvement in BSCVA (mean ± SD = -0.34 ± 0.50 logMAR); mild hyperopic shift (mean ± SD = 0.48 ± 1.7 D); and stability in IOP measurements (mean ± SD = 0.19 ± 4.8 mm Hg). There were no significant differences in groups according to donor graft thicknesses with respect to change in BSCVA (P = 0.8); hyperopic shift (P = 0.76); or IOP measurement (P = 0.56). CONCLUSIONS: DSAEK significantly improves BSCVA. DSAEK graft thickness may not play an important role in the final BSCVA, refractive error, or accuracy of IOP measurement. The ideal DSAEK graft thickness to minimize graft-related complications remains to be determined.