Corneal Neovascularization: From Pathogenesis to Therapeutic Strategies

Corneal neovascularization is a pathological response to corneal injury and inflammation characterized by the abnormal growth of blood vessels into the normally avascular cornea, resulting in corneal opacity, scarring, lipid deposition, and impaired visual function. Its development is driven by a complex imbalance between pro- and anti-angiogenic factors and is closely associated with inflammatory responses, immune activation, and tissue remodelling. Despite advances in understanding these mechanisms and the availability of various treatments, effective management of persistent and established corneal neovascularization remains challenging, particularly because existing therapies may provide incomplete or temporary vascular regression. This review provides an overview of the molecular and cellular mechanisms underlying corneal neovascularization and critically evaluates established therapeutic approaches, as well as emerging molecular and adjuvant therapies. Emphasis is placed on their therapeutic potential, current limitations, and the challenges of achieving effective and sustained vascular regression. Finally, future perspectives are discussed, highlighting the need for more targeted and durable therapeutic approaches that address the multifaceted mechanisms underlying pathological corneal neovascularization. A deeper understanding of these mechanisms may facilitate the development of more effective treatments and ultimately contribute to improved corneal transparency and visual outcomes.