Corneal Biomaterials in Regenerative Ophthalmology: Scaffolds, Bioprinting and Keratoprosthetic Technologies.

Abstract

To review current and emerging biomaterial-based strategies for corneal repair and replacement, with emphasis on biological scaffolds, biofabricated constructs, artificial stromal substitutes, and keratoprosthetic technologies. Literature review. Review of experimental, translational, and clinical literature on biomaterial platforms for corneal reconstruction, including decellularized matrices, collagen-based and extracellular matrix-derived scaffolds, three-dimensional printed and bioprinted constructs, endothelial carrier systems, and synthetic and biologic keratoprostheses, with particular attention to layer-specific applications. Corneal biomaterials are progressing from passive substitutes to increasingly sophisticated regenerative and prosthetic platforms. Biological scaffolds such as decellularized cornea, collagen-based implants, and amniotic membrane derivatives may support epithelial, stromal, and endothelial repair, whereas three-dimensional printing and bioprinting now enable more precise, layer-specific constructs. Endothelial tissue engineering appears particularly promising, with bioengineered grafts and synthetic barrier devices showing encouraging early results. Keratoprostheses remain the most clinically mature option for end-stage disease but continue to be limited by sequala of incomplete biointegration. Across platforms, key barriers to routine clinical use include long-term durability, optical stability, manufacturability, and regulatory complexity CONCLUSIONS: Biomaterial-based corneal reconstruction is entering a translational era in which layer-specific and hybrid approaches may expand therapeutic options beyond conventional keratoplasty. Continued progress will depend on improving biologic integration, long-term functional durability, and alignment of biomaterials innovation with surgical and regulatory realities.