We describe a case of early onset keratectasia after photorefractive keratectomy (PRK) in a patient with Vertical D topographic pattern in one eye and suspected keratoconus in the other eye.A 31-year-old woman underwent bilateral PRK: attempted correction was -8.00-2.00 × 30° in her right eye (RE) and -4.50-1.50 × 150° tabo in her left eye (LE). Preoperative corneal thickness was 512 µm in the RE and 520 µm in the LE. Preoperative topography showed an asymmetric bow-tie pattern and skewed axis in RE and a Vertical D pattern in LE. Intended maximum ablation was 91 µm in RE and 66 µm in LE.Three months postoperatively the patient showed early topographic signs of bilateral keratectasia, evolved to manifest keratectasia after six years.Although rare after PRK, keratectasia may occur even following moderate (66 µm) surface ablation in eyes with Vertical D topographic pattern in one eye and controlateral suspected keratoconus.