This was a retrospective data review on all patients who underwent primary descemet stripping automated endothelial keratoplasty (DSEAK) during a 10 year period: 1212 eyes were included in the analysis. Postoperative graft detachment occurred in 45 eyes (3.7%) and required anterior chamber re-bubbling on same day. No graft experienced a second detachment. One graft had primary failure after re-bubbling and was exchanged. Factors associated with graft detachment included indications for graft other than Fuchs’ endothelial dystrophy or bullous pseudophakic oedema, medically treated glaucoma, previous trabeculectomy or previous aqueous shunt surgery. In multivariate analysis previous trabeculectomy and previous failed penetrating keratoplasty were associated with increased risk of graft detachment. Aphakia, anterior chamber lens or combined simultaneous cataract and graft surgery were not associated with graft detachment. This study demonstrates which patients are particularly at risk for DSAEK graft detachment, and in whom preventative measures should be considered during surgery.