Retrospective analysis of results following primary and secondary descemet stripping automated endothelial keratoplasty (DSAEKs), carried out in Villa Serena-Villa Igea Private Hospitals in Italy, showed that primary and secondary DSAEK surgery result in similar visual outcomes, refractive errors and endothelial cell loss. Out of 1413 surgeries performed within 10 years, 89 eyes required secondary DSAEK and five eyes required third DSAEK. The indications for a repeat DSAEK were slowly progressive endothelial cell loss (68.6%), endothelial rejection (29.4%) and host-graft interface abnormalities (1.9%). Mean interval between subsequent surgeries was 2.2 years. Of the repeat DSAEKs, 82.3% had at least six months of follow-up data after the second surgery. There were no significant differences between postoperative best spectacle corrected visual acuity (BSCVA), spherical equivalent and absolute astigmatic errors. Postoperative endothelial cell loss (ECL) rates were available for 39% of eyes and endothelial cell loss rates for primary and repeat DSEAKs were similar for both groups at both one and two years. This study confirms repeat DSEAK to be as effective as the primary procedure.