We describe the long-term clinical outcomes of selective endotheliectomy in Peters anomaly (SEPA) while preserving the host Descemet membrane, a relatively new technique to manage a select group of children with PA. Also, this video highlights indications, the timing of surgery and surgical procedure, intraoperative challenges and postoperative care. SEPA is a safe, effective technique in select cases of posterior corneal defect due to PA. This could be a potential novel surgical alternative that could reduce the need for full-thickness keratoplasty.