Purpose: The purpose of this article is to highlight the challenges faced during non–descemet stripping endothelial keratoplasty (n–DSEK) and the outcome in pediatric patients. METHODS Design: Eight eyes of six children with corneal decompensation [Congenital hereditary endothelial dystrophy (05), failed Penetrating Keratoplasty (02) and toxic endothelitis (01)] who underwent n–DSEK, were prospectively followed for visual acuity, corneal thickness and complications. Intraoperative challenges encountered during n–DSEK were also evaluated. All the patients were evaluated pre–operatively under slit–lamp. Refraction and initial visual acuity was documented. Postoperative follow up was done at day 1, 7, 30, 12 weeks and at 6 months. Subsequent, follow up was done at 12 and 18 months postoperatively. Results: All patients completed 6 months of follow–up. Mean visual acuity (VA) in LogMar at 3 months and 6 months was 0.73 & 0.43 respectively. VA improved significantly and corneal thickness also reduced at 3 (p<0.05.) & 6 (p<0.05) months post–operatively. 2 out of 8 eyes had lenticule dislocation at 7th postoperative day . They were managed successfully by re–bubbling. Intraoperative challenges faced were: while making incision, descematorrhexis, peripheral iridotomy, sheet glide insertion and air tamponade and were managed by using cohesive viscoelastic, deeper anesthesia and multiple suture placement respectively. Conclusions: Inspite of multiple intraoperative challenges the n–DSEK seems to be a promising surgical procedure in children with corneal endothelial decompensation.