Although small, peripheral, cystic, or putty-gray infiltrates were observed along the suture tracks in 20 of 100 pediatric patients after epikeratophakia at Louisiana State University Medical Center, New Orleans, they progressed to clinically significant opacities in only three. In one, the interface material was curetted and the lenticule was reattached. The removed material was identified histologically as epithelial cells in varying states of degeneration. In a second case, the graft became hazy and the opacity involved most of the interface. The lenticule was removed, and epikeratophakia was again performed. On the posterior surface of the removed lenticule was a multilayered epithelium that had infiltrated into adjacent stromal lamellae. In the third case, a clear cyst resolved without intervention over a five-year period. These cases illustrate the importance of meticulous removal of all surface epithelium and the necessity for copious irrigation of epithelial debris intraoperatively. Epithelial ingrowth should not be confused with bacterial infection. Such opacities can be treated by curettage or aspiration of the invading material or removal of the epikeratophakia lenticule if spontaneous resolution does not occur.