We performed epikeratophakia for the correction of aphakia in 31 children, ages 2 months to 7 years, who had unilateral congenital or traumatic cataracts. In 27 patients with more than 4 months of follow-up, 23 of 30 (77%) grafts were successful. In the 15 patients with 6 months or more followup, the average increase in corneal curvature was 12.39 diopters. The average overrefraction needed to achieve emmetropia was + 2.14 diopters spherical equivalent. Two patients operated on within the first year of life have achieved 6/15 (20/50) visual acuities, as measured by visual evoked potentials. One patient operated on in the second year of life achieved 5/30 visual acuity, as measured by Allen cards. Two patients operated on for traumatic cataracts at ages 2 and 4 years achieved 6/9 (20/30) and 8/30 (Allen cards) visual acuities, respectively. Five older patients who had congenital cataracts or persistent hyperplastic vitreous showed some improvement in visual function. Advantages of epikeratophakia include the placement of most of the correction directly on the eye in a permanent attachment and the elimination of contact lens manipulation in uncooperative patients, so that more time and energy can be devoted to the occlusion therapy.