Adhesive bioactive materials in ocular applications: Toward smart, regenerative, and minimally invasive therapies

Ocular adhesive bioactive materials represent a paradigm shift in ophthalmic surgery and tissue repair, offering sutureless solutions with enhanced biocompatibility, reduced complications, and improved clinical outcomes. Designed to function as sealants, defect fillers, and delivery vehicles for drugs or cells, these materials must meet the stringent physiological and optical demands of the ocular environment. They are typically classified by anatomical application (ocular surface vs. fundus) and material origin (natural vs. synthetic), and rely on diverse crosslinking strategies to achieve tailored mechanical and adhesive properties. Current design approaches increasingly embrace biomimetic principles-aiming to replicate the structural and functional characteristics of native ocular tissues-to improve integration and therapeutic effectiveness. Moreover, the combination of adhesive materials with regenerative therapies such as stem cells, and exosomes extends their potential from simple structural support to active tissue regeneration. This review provides a comprehensive synthesis of ocular adhesive bioactive materials, outlines major design strategies and applications, and highlights future directions toward personalized and programmable regenerative platforms capable of addressing complex ophthalmic challenges.