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Introduction Endothelial keratoplasty is a posterior lamellar corneal transplantation technique. Three types of endothelial graft are distinguished: DSAEK, UT DSAEK and DMEK, depending on whether it is transplanted, Descemet’s membrane and a variable thickness of stroma (DSAEK and Ultra-thin DSAEK) or only Descemet’s membrane and endothelium (DMEK). The detachment of the endothelial flap after surgery and the consequent need to inject air into the anterior chamber (rebubbling) to promote the adhesion of the endothelial lenticule is among the most frequent complications. In our study, we analyzed what are the factors that influence a higher incidence of rebubbling in the DSAEK technique, focusing on the characteristics of the endothelial flap, the donor and the recipient patient.Materials and Methods We analyzed 98 DSAEK and Ultra-thin DSAEK surgeries performed at a single center (Hospital S.Maria delle Croci of Ravenna): 49 (50.0%) in 2023 and 49 (50.0%) in 2024. Out of 98 endothelial keratoplasty, 31 needed rebubbling: 13 (41.9%) in 2023 and 18 (58.1%) in 2024. The sample was divided into two groups: ‘yes’ and ‘no’ rebubbling. The difference between the two groups was evaluated with statistical tests (Pearson χ2 test, Fisher test, Student’s t test and Mann-Whitney test, depending on appropriateness). We performed 5 multivariate logistic regression models to evaluate the association between rebubbling and the variables under study : donor age, pseudophakic donor, pseudophakic recipient, combined phacoemulsification and DSAEK surgery, period between the tissue donor collection and the culture performed in the Eye Bank after the morphological evaluation, cornea time storage in culture medium, time interval between culture performed in the Eye Bank after the morphological evaluation and tissue transfer into the deturgescence medium.Results A statistically significant difference is observed between ‘yes’ and ‘no’ rebubbling groups for the ‘pseudophakic donor’ variable and for ‘the period between tissue donor collection and the culture performed in Eye Bank after morphological evaluation’. The patient who receives tissue from a pseudophakic donor has a higher risk of rebubbling. It seems that a longer ‘period between the tissue removal from the donor and the culture performed in the Eye Bank after the morphological evaluation’ increases the rebubbling incidence. In multivariate logistic regression models 1 and 2, the age of the recipient is a protective factor: the risk of rebubbling decreases with the age increasing of the recipient. While a pseudophakic donor and the time interval between tissue collection and storage in the Eye Bank after morphological evaluation are risk factors for flap detachment and therefore for rebubbling. In models 3 and 5 the significant associations are: the age of the recipient as a protective factor and the presence of pseudophakia in the donor as a risk factor, in model 4 no significant association is observed.Conclusions In our study, the significant risk factors for flap detachment and hence rebubbling are: pseudophakic donor and time interval between tissue collection and storage in the Eye Bank after morphological evaluation. In contrast, the age of the recipient was found to be a protective factor.