The purpose of this study was to evaluate the experience of patients with Peters anomaly (PA) and their treatment results. The study reviewed records of 27 patients (32 eyes); 74% male. Treatment included medical follow-up, optical iridectomy and penetrating keratoplasty with or without lensectomy / vitrectomy for type I PA. Type II treatment included penetrating keratoplasty, lensectomy and anterior vitrectomy. All were treated for amblyopia. Five patients were bilateral and 22 were unilateral. Average age at first assessment was 57.62 days (median 39 days). Average age at first surgery was 151 days (median 103). Average follow-up was 10.2 years. Pre and post IOP was 22 ±7.87mmHg and 21 ±10.61mmHg respectively. If IOP was >25mm, patients were given topical hypotensive glaucoma treatment. Fifteen patients (17 eyes) were type I and 12 (15 eyes) were type II. Overall visual acuity results were 1.71 ±1.04 logMAR. Type I; 0.30 ±0.00 logMAR with medical treatment, 0.97 ±0.78 with peripheral iridectomy and 1.22 ±0.97 with penetrating keratoplasty. Type II; 2.41 ±0.80 logMAR without posterior pole compromise and 2.56 ±0.48 with posterior pole compromise. Type I had a 50% graft failure: 55% failure in type II without posterior pole compromise and 75% in type II with posterior pole compromise. The authors suggest surgical management should always be offered for a compromised eye due to severity of the anomaly and to offer a chance of improved visual function. They propose an assessment and management scheme for these patients dependent on type and associated characteristics.