Progressive keratectasia is an uncommon but severe complication of refractive surgery. Preoperative ectatic corneal disease is the most critical risk factor. An advanced multimodal diagnostic screening for subclinical ectasia is essential to avoid this complication. This chapter discusses a case of iatrogenic corneal ectasia resulting from small-incision lenticule extraction (SmILE) and its management using a combination of intracorneal ring segment implantation and epi-ON crosslinking. Emphasis is placed on the importance of thoroughly assessing the risk of ectasia before undergoing laser vision correction (LVC) procedures utilizing multimodal imaging. This assessment aims not only to detect mild (subclinical or fruste) forms of keratoconus but also to understand the predisposition to biomechanical failure and ectasia progression, considering the impact of the LVC procedure itself. The retrospective analysis of clinical data illustrates the significance of this enhanced risk assessment approach. Drawing inspiration from aviation’s black-box thinking, which involves examining data recordings after accidents to prevent future occurrences, the chapter suggests applying a similar approach to identify risk factors and prevent progressive keratectasia following refractive corneal surgery.