Theranostic-guided Corneal UV Photoreshaping: A Novel Methodology for Treatment of Keratoconus

Aim and background: This study aims to describe a novel theranostic-guided corneal ultraviolet (UV) photoreshaping technique for the treatment of keratoconus, integrating a theranostic UV device with corneal iontophoresis-assisted, spatially patterned 0.22% riboflavin delivery.Materials and methods: The platform combines real-time UV-A light-triggered theranostic feedback of corneal response with a corneal iontophoresis system for spatially patterned delivery of riboflavin.The controlled accessory system allows for the delivery of higher riboflavin concentration in the central treatment zone compared with surrounding areas, using a 0.22% riboflavin ophthalmic formulation.Treatment protocol, device specifications, and mechanism of action are described.The first three cases were prospectively evaluated at 6 months postoperatively, with outcomes including changes in maximum keratometry (K max ) and corrected distance visual acuity (CDVA).Results: All cases demonstrated early K max flattening (≥1.3 D) and significant improvement in CDVA (≥0.3 logMAR), and no adverse events at 6-month follow-up.Under theranostic-guided UV-A irradiation, the spatially patterned riboflavin delivery enabled selective biomechanical reinforcement of the cornea, which contributed to measurable improvements in corneal optics and visual function.Conclusion: Theranostic-guided corneal UV photoreshaping is a feasible and safe therapeutic option for keratoconus.Early results suggest potential for both stabilization of ectatic progression and improvement of visual performance.Further studies with larger cohorts and longer follow-up are warranted to validate these findings.Clinical significance: This innovative, non-invasive therapeutic strategy has the potential to both halt keratoconus progression and enhance visual acuity, without the need for corneal incisions.