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Endothelial cell density (ECD) after DSAEK was significantly smaller in eyes with IDES when compared with those without at all time points (p&lt;0.001) despite no significant difference in graft ECD (p=0.43), resulting in an increased rate of endothelial failure (p=0.044). The presence of glaucoma (OR=2.22, p=0.027), iris damage (OR=2.85, p=0.004) and non-Fuchs status (OR=2.37, p=0.018) were identified as risk factors for IDES development. 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