Peters anomaly (PA) type 1 is characterized by focal absence posterior corneal stroma and Descemet membrane endothelial complex. A conservative approach is often unsuccessful except in milder variants, and corneal grafting can have unpredictable long-term outcome. This video illustrates a relatively new surgical strategy for the management of a central corneal opacification in children due to Peters anomaly. Selective endothelial removal is a safe, effective technique in select cases of posterior corneal defect due to Peters anomaly. This could be a potential novel surgical alternative that could reduce the need for full-thickness corneal grafting.