A 35-year-old man presented with bilateral high astigmatism following penetrating keratoplasties performed for advanced keratoconus. Femtosecond laser-enabled intrastromal astigmatic keratotomy was performed, resulting in a significant reduction in corneal astigmatism. At 4 months, the corneal astigmatism continued to decrease. The visual acuity, refraction, and serial corneal topographic data are presented. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.