Abstract： Background With advances in pediatric keratoplasty over the last two decades, the success rate of surgery has increased remarkably. However, few epidemiological studies in this field have been performed in China. The present study investigated the indications and characteristics of pediatric penetrating keratoplasty in Shanghai.Methods All records of pediatric keratoplasty performed on 156 eyes in 149 children (<14 years) at four ophthalmic units in Shanghai during a 5-year period (2003-2007) were used for this retrospective study. Patients were from the Eye,Ear, Nose & Throat Hospital of Fudan University, Shanghai No.10 People's Hospital, Shanghai No.1 People's Hospital,and Shanghai Peace Ophthalmology Hospital; and included mostly school-age children (97 boys and 59 girls).Results The median age at surgery was 9 years with an interval quartile range of 6-12 years. Scarring after keratitis (29.5%, 46/156) and traumatic corneal scar (19.2%, 30/156) were the most common indications. Best Corrected Snellen visual acuity (BCSVA) was reported only in 72% (112/156) of cases. Visual acuity outcomes were significantly better for keratoplasty 1 year postoperatively compared to preoperative visual acuity (P=0.001). Of all patients, 13% (14/112) achieved a BCSVA of 6/18 or better. None of the indications was associated with a higher rate of failure compared to after 1 year follow-up.Conclusion We obtained valuable information on pediatric keratoplasty in Shanghai. There was no significant difference in graft survival rate among the two indications. Vision outcomes after corneal transplantation in Chinese children were significantly better compared with pre-operation status. In conclusion, corneal graft survival can be achieved in childhood.