Exosome-based therapies for corneal disorders: current status and future perspectives

Exosomes, extracellular vesicles packed with diverse bioactive molecules, show significant promise as therapeutic agents for corneal disorders. This review provides an overview of the current landscape and future outlook of exosome-based therapies in ophthalmology, with a focus on corneal disease. We summarize the fundamental biology and characteristics of corneal exosomes and discuss their roles in maintaining corneal homeostasis and driving disease processes. The therapeutic potential of exosomes in corneal ulcers, dry eye disease (DED), scarring, and dystrophies is evaluated, highlighting preclinical evidence that exosomes can promote epithelial wound healing, modulate inflammation and fibrosis, and support tissue regeneration, as well as emerging clinical studies that begin to assess their safety and feasibility. We also address critical aspects of exosome isolation, characterization, engineering, and delivery strategies that are relevant for clinical translation. Despite encouraging preclinical findings, significant challenges remain, particularly in standardizing manufacturing and quality control, ensuring safety, and achieving consistent therapeutic efficacy. Future research should focus on optimizing exosome production and delivery, rationally engineering them to enhance therapeutic performance, and exploring their potential as biomarkers. Overall, exosome-based therapies hold substantial promise for transforming the management of corneal diseases, but further rigorous translational and clinical studies are required to realize their full potential.