The field of penetrating keratoplasty has reached an exciting stage in its development. At one time, corneal transplantation in children was considered to have a very high chance of failure and even contraindicated. Because of advances in surgical technique and postoperative care, a clear transplant can now often be attained in an infant or a child. Therefore, penetrating keratoplasty is no longer contraindicated in pediatric patients. In fact, prompt penetrating keratoplasty is a necessary first step in averting irreversible loss of visual function due to amblyopia. The visual results of pediatric penetrating keratoplasty, however, are often disappointing. Many unique difficulties encountered in the management of an infant or a child requiring corneal transplantation conspire to make these patients among the most challenging for the corneal surgeon.