A summary of experience in pediatric keratoplasty is given by adding ten recent cases to a previous report. A review of keratoplasty in infants and children from the literature generally recommends the procedure as safe and effective. Recent reports, however, cast some doubt on the effectiveness of the procedure for certain conditions. An update of experience is given as a focal point for a discussion of problems in clinical management of children who undergo keratoplasty. These problems are arbitrarily separated by pre-, intra-, and postoperative time frames.