Abstract
With the increasing prevalence of microplastics (MPs) and nanoplastics (NPs) in global aquatic environments, their potential ecotoxicological and health impacts have become a major concern in environmental science. Slow sand filtration (SSF) is widely recognized for its low energy demand, ecological compatibility, and operational stability; however, its efficiency in removing small or neutrally buoyant MPs remains limited. In recent years, integrating modified activated carbon (MAC) into SSF systems has emerged as a promising approach to enhance MP removal. This review comprehensively summarizes the design principles, adsorption and bio-synergistic mechanisms, influencing factors, and recent advancements in MAC-SSF systems. The results indicate that surface modification of activated carbon—through controlled pore distribution, functional group regulation, and hydrophilic–hydrophobic balance—significantly enhances the adsorption and interfacial binding of MPs. Furthermore, the coupling between MAC and biofilm facilitates a multi-mechanistic removal process involving electrostatic attraction, hydrophobic interaction, physical entrapment, and biodegradation. In addition, this review discusses the operational stability, regeneration performance, and environmental sustainability of MAC-SSF systems, emphasizing the need for future research on green and low-cost modification strategies, interfacial mechanism elucidation, microbial community regulation, and life-cycle assessment. Overall, MAC-SSF technology provides an efficient, economical, and sustainable pathway for microplastic control, offering valuable implications for a safe water supply and aquatic ecosystem protection in the future.