To investigate whether entire recipient's Descemet stripping reduced endothelial cell loss (ECL) following Descemet membrane endothelial keratoplasty (DMEK) for iridocorneal endothelial (ICE) syndrome DESIGN: Randomized controlled clinical trial SETTING: Zhongshan Ophthalmic Center PATIENT: Forty-eight patients (48 eyes) with ICE syndrome were enrolled between March 10, 2014, and May 11, 2022. The eligible patients were divided into the entire recipient's Descemet stripping group (the entire stripping group, 24 eyes) or the standard technique group (the standard group, 24 eyes). DMEK was performed in all cases with concomitantly procedures. The entire recipient's Descemet membrane or the central 8.0 or 8.25-mm diameter of the Descemet membrane was removed intraoperatively. ECL, corrected distance visual acuity (CDVA), intraocular pressure (IOP), graft survival, and surgical complications were compared 9, 12 and 24 months after surgery. After a 9 months follow-up, ECL was significantly lower in the entire stripping group than in the standard group. At 2 years postoperatively, the ECL rate was 66±5% and 74±4% (95%confidence interval (CI): -0.04 to 0.01; p = 0.040), with a cumulative graft success rate of 83% and 67% (95%CI: -0.07 to 0.39; p = 0.318) in the entire stripping group and the standard group, respectively. Postoperative CDVA level was comparable between the 2 groups throughout the follow-up period. No significant differences were observed in the incidence of main complications between the 2 groups. Entire recipient's Descemet stripping may delay the pathological progression of ICE syndrome, thereby reducing ECL following DMEK.