Therapeutic Advances in Corneal Scar Management: Topical Treatments, Mesenchymal Cell Therapy, and Stromal Transplantation.

Abstract

To provide a comprehensive overview of the current and emerging therapeutic strategies for corneal scarring, focusing on various topical pharmacologic agents, cell-based and cell-free therapies, and bioengineered stromal substitutes as alternatives to traditional corneal transplantation. Perspective review. A comprehensive literature search was conducted to identify relevant studies on corneal scarring, associated pathophysiology, and treatment modalities. We also screened the reference lists of relevant articles and reviews. Emphasis was placed on topical anti-inflammatory and antifibrotic therapies, cell-based therapies and their secretome and extracellular vesicles, advances in biomaterials, hydrogels, and 3-dimensional bioprinting for stromal reconstruction. Corneal scarring results from dysregulated wound healing, characterized by myofibroblast differentiation and disorganized extracellular matrix deposition. Conventional therapies provide limited and short-term benefits. Emerging antifibrotic agents, such as losartan and decorin, target key profibrotic pathways and demonstrate therapeutic potential. Cell-free approaches, including conditioned media, exosomes, and microRNA-based strategies, have anti-inflammatory and regenerative effects without the limitations of cell transplantation. Mesenchymal stem cells have efficient paracrine-mediated immunomodulatory properties, although challenges in standardization and clinical translation remain. Biomaterial-based strategies, including collagen scaffolds, decellularized matrices, hydrogels, and 3-dimensional bioprinting, are being developed as alternatives for corneal repair. Recent advancements in regenerative medicine and bioengineering provide viable alternatives to corneal transplantation that rely on donors. Although these techniques have had some preclinical success, more standardization, safety validation, and extensive clinical studies are necessary to confirm their long-term efficacy and facilitate routine clinical implementation in the management of corneal scars.