PURPOSE The corneal status of patients with primary angle-closure glaucoma (PACG) with a history of acute attack was investigated. METHODS This cross-sectional study included 40 eyes of PACG patients with an earlier documented symptomatic acute angle-closure attack (aPACG), 40 uninvolved fellow eyes of aPACG patients (fPACG), 44 eyes of chronic PACG patients without such a history (cPACG), and 50 eyes of age-matched normal participants. All glaucoma patients had patent peripheral iridotomies with adequate intraocular pressure control. The examinations and recorded parameters included visual acuity, intraocular pressure, gonioscopy, vertical cup-to-disc ratio, specular microscopy, central corneal pachymetry, refraction, corneal curvature radius, anterior chamber depth, axial length, and lens thickness measurements, and the presenting intraocular pressure and the duration of acute angle-closure attack for aPACG eyes. RESULTS The mean endothelial cell density was 2271±80 cells/mm(2) in aPACG, 2458±79 cells/mm(2) in fPACG, 2379±50 cells/mm(2) in cPACG, and 2559±45 cells/mm(2) in controls. The aPACG eyes had significantly lower endothelial cell density compared with normal eyes (P=0.002). There was no significant difference in endothelial cell density of aPACG eyes compared with fPACG or cPACG eyes. Multivariate analysis showed the duration of the acute attack was the only factor independently associated with corneal endothelial density of aPACG eyes. The mean central corneal thickness of aPACG (549±32 μm) did not differ significantly from control eyes (552±27 μm), cPACG (557±32 μm), and fPACG (553±31 μm) (P=0.911, 0.274, and 0.725, respectively). Corneal curvature radius of aPACG eyes was not significantly different from that of the comparison groups (all P>0.05). CONCLUSIONS Corneal endothelial cell density was significantly reduced in aPACG eyes compared with normal eyes. No significant difference in endothelial cell density of aPACG eyes was noted when compared with fPACG or cPACG eyes. Corneal endothelial cell density was negatively associated with the duration of the acute attack, but was not associated with demographic and biometric characteristics. Central corneal thickness and corneal curvature radius were not associated with an earlier acute angle-closure attack.