Objective: To evaluate the preliminary visual results of femtosecond laser-assisted descemet stripping endothelial keratoplasty (FS-DSEK). keratoplasty (FS-DSEK). Methods: We prospectively analyzed results of 20 consecutive patients with Fuchs endothelial dystrophy or aphakic/pseudophakic bullous keratopathy who underwent FS-DSEK. Best spectacle-corrected visual acuity (BSCVA), refraction, corneal topography, and endothelial cell density were measured preoperatively and 3 and 0 months after FS-DSEK. Conical thickness was measured using all optical coherence tomography technique. Results: The average BSCVA of 11 eyes with normal visual potential significantly improved from 20/110 +/- 4 lines to 20/57 +/- 1 line at 6 months (P<.007). At 6 months, the mean (SD) hyperopic shift was 2.24 (2.3) diopters (D). Pre-operative and 6 months postoperative refractive astigmatism were -0.75 (0.9) D and -1.58 (1.1) D (P=.01), but the topographic astigmatism did not change postoperatively (P=.95). Mean (SD) endothelial cell density at 6 months was 1368 (425) cells/mm(2). There was a persistent deswelling of the graft up to 3 months postoperatively. Complications included graft dislocations requiring repositioning (20%), pupinary block glaucoma (5%), epithelial ingrowth (5%,), and primary graft failure (5%). Conclusions: Femtosecond laser-assisted Descemet stripping endothelial keratoplasty was effective in treating endothelial failure with minimal induced refractive astigmatism, limited improvement of BSCVA, and induction of a hyperopic shift. Endothelial cell count and dislocation rate were significant, which may be related to the surgical technique.