Emerging approaches for ocular surface and corneal stromal regeneration: Recent advances and future perspectives

Corneal blindness affects millions worldwide, with a particularly high burden in developing regions, especially in Asia and Africa. In India, the scarcity of donor corneal tissue and challenges in post-transplant care complicate efforts to address this issue. While enhancing the eye banking network and increasing surgical training remain important, corneal transplantation alone cannot address the problem, particularly for high-risk cases such as trauma, infections, and degenerative diseases, which often have poor long-term outcomes. Advances in regenerative medicine and bioengineering offer promising alternatives. Cell-based therapies, including cultivated limbal epithelial and mesenchymal stem cell treatments, aim to restore corneal function through the modulation of native cell behavior. Additionally, cell-free therapies, such as exosomes, decorin, and extracellular matrix derivatives, provide innovative, donor-independent options to reduce scarring and promote healing. Bioengineered corneas and hydrogel scaffolds further reduce dependence on donor tissue, expanding treatment possibilities and alleviating donor shortages. The successful integration of these therapies into clinical practice requires collaboration between research institutions and industry, along with localized manufacturing to ensure affordability and accessibility. To support these advancements, eye banks may need to evolve into comprehensive cell and tissue facilities, ultimately expanding care options for patients with corneal blindness in resource-limited settings.