This chapter provides an extensive review of post-refractive corneal ectasia. The text delves into both established and potential risk factors for the development of postoperative ectasia, including ectatic corneal diseases, low residual stromal bed thickness, increased tissue alteration percentages, young age, and family history. It underscores the critical need for comprehensive preoperative screening approaches and the usefulness of alternative surgical options for at-risk individuals. Additionally, management strategies for postoperative ectasia are explored, emphasizing the role of corneal crosslinking, contact lenses, and novel treatments in visual rehabilitation. The chapter also highlights emerging measurement techniques and the integration of artificial intelligence for enhanced identification and management of patients at risk.