A 27-year-old man had excimer photoastigmatic keratectomy in the right eye and laser in situ keratomileusis in the left eye for the treatment of equivalent myopia. Preoperative slitlamp examination did not reveal evidence of keratoconus, central corneal pachymetry was 485 microm in the right eye and 500 microm in the left eye, and corneal topography revealed asymmetric bow-tie astigmatism with inferior steepening in the right eye and a small area of inferior steepening in the left eye. Twenty-two months after surgery, the patient complained of poor vision in the left eye. Slitlamp examination of the left eye revealed central corneal thinning and protrusion, with a Fleischer ring within the flap. Corneal topographic evaluation revealed a stable map in the right eye and central corneal steepening indicative of keratectasia in the left eye.