We present a case of late high progressive astigmatism following penetrating keratoplasty for keratoconus, which was associated with peripheral thinning in the donor-receptor area, which may be recognized as recurrence of ectasia. Treatment was accomplished with Cvintal’s Topoplasty assisted by femtosecond laser for a “top hat”, followed by resuture with peroperative adjustment guided by ceratoscopy.