Dynamic regulation mechanisms of macrophages and advances in targeted therapy for corneal injury repair.

Corneal injury is a major cause of visual impairment worldwide and involves a tightly regulated cascade of inflammation, tissue repair, and remodeling. This process typically progresses from an early inflammatory phase to proliferative repair and ultimately to stromal remodeling, with potential outcomes including corneal neovascularization and fibrosis that compromise transparency and vision. Accumulating evidence highlights macrophages as central regulators across these stages. In the early phase, pro-inflammatory (M1-like) macrophages mediate pathogen clearance and immune activation through cytokines such as IL-1β and TNF-α. During the reparative phase, a transition toward anti-inflammatory (M2-like) phenotypes facilitates epithelial regeneration, extracellular matrix remodeling, and resolution of inflammation. Dysregulation of this dynamic balance, however, contributes to chronic inflammation, pathological angiogenesis driven by hypoxia-inducible factor-vascular endothelial growth factor signaling, and TGF-β-mediated fibrotic remodeling. We summarize current understanding of macrophage-associated signaling networks in corneal injury, including pathways governing inflammation, angiogenesis, and fibrosis, and highlights emerging macrophage-targeted therapeutic strategies such as cytokine modulation, nanocarrier-based delivery, and gene editing approaches. Despite promising preclinical results, challenges including macrophage heterogeneity, temporal specificity, and translational safety remain. A deeper mechanistic understanding may enable the development of more precise immunomodulatory therapies to improve corneal repair and visual outcomes.