Corneal Epithelial Tissue Engineering Strategy Based on Cell Viability Optimization: A Review and Prospects

Corneal transplantation is often considered the last resort for severe corneal epithelial disorders, especially limbal stem cell deficiency (LSCD). Tissue engineering offers novel strategies to mitigate the shortage of corneal transplant donors. However, low cell viability and compromised functionality in tissue engineering represent a major challenge. In this review, we describe the key characteristics required for corneal epithelium bioscaffolds. We summarize the research progress centered on optimizing cell activity and functionality in the past 10 years from four key perspectives: the sourcing of cells, seed cell pretreatments, biomaterial optimization, and engineered culture system innovation. The sources, isolation, and induction methods of seed cells are described, and the advantages and disadvantages of existing clinical treatment methods are compared. Furthermore, we compare existing clinical therapies and summarize promising seed cell pretreatment strategies for the first time. Several innovative engineered cell culture systems are exhibited as well. We demonstrated how to preserve cell viability through bioscaffold stiffness modulation, topographic design, and application of innovative fabrication techniques. Finally, we propose a personalized and precise regeneration strategy based on high-resolution images, digital modeling, bioprinting, and machine learning.