There are different ways to surgically manage visually significant central corneal scarring in children and infants. The traditional (and usual) procedure is a penetrating keratoplasty (PKP). This chapter will examine lamellar keratoplasty (LKP) as an option in pediatric patients with anterior stromal corneal scarring. Both the techniques worked well with good graft clarity and visual improvement. Therefore, lamellar keratoplasties in children do well, and should be considered in children who have anterior corneal stromal opacities. The MLKP technique, however, is a “work-in progress”. It is difficult to use in younger, smaller eyes. In these children, we cannot insert the microkeratome plate. However, in older children (older than 4 to 5 years of age), with anterior corneal opacities who have larger eyes, the microkeratome plate can be inserted. Also, we can usually obtain keratometry, pachymetry, and a slit-lamp examination before surgery. This allows us to take advantage of the benefits of the automated MLKP technique. This technique, therefore, should be used as the lamellar procedure of choice in older children with anterior corneal opacities. As these lamellar procedures are technically demanding, it is essential that the surgeon is very well experienced in lamellar corneal surgery before attempting pediatric LKP.