A team of surgeons in New York has achieved a groundbreaking medical milestone by conducting the world’s first transplant of an entire eye. The procedure has been widely called a medical breakthrough. However, it remains uncertain whether the recipient will eventually see through the donated eye.
The groundbreaking surgery involved removing part of the face and the whole left eye — including its blood supply and optic nerve — of a donor and grafting them onto a high-voltage utility line worker from Arkansas who survived a 7,200-volt electric shock in June 2021.
Aaron James, 46, suffered extensive injuries including the loss of his left eye, his dominant left arm above the elbow, his nose and lips, front teeth, left cheek area and chin. However, his right eye still in working condition.
James was referred to NYU Langone Health, a leading medical centre for facial transplants, where he underwent a rare partial face transplant on May 27 this year, along with the eye transplant, a complex procedure that engaged over 140 healthcare professionals.
Transplanting an entire eye has long been a holy grail of medical science, and though researchers have had some success in animals — where they have restored partial vision — it’s never before been performed in a living person.
“It’s uncharted territory, but we’re looking forward to the exploration,” Eduardo Rodriguez, who led the surgery, said in an interview.
It was Rodriguez’ fifth face transplant, and “we’ve been able to trim the time from where I started in 2012 from 36 hours to now 21,” he said, adding face transplants are no longer an experimental procedure and should be considered “standard of care” in certain cases of severe disfigurement.
The transplanted left eye appears very healthy, said retinal ophthalmologist Vaidehi Dedania. It has a good blood supply, is maintaining its pressure, and is generating an electrical signal, though James is not yet able to see.
“But we have a lot of hope,” she added.
Doctors have reported that direct blood flow to the retina has been established. The retina, which is responsible for sending images to the brain, now has improved blood circulation.
And though the certainty of regaining vision remains uncertain, medical professionals acknowledge the possibility, the BBC reported.
James, who is a military veteran, expressed optimism and said, “If I can see out of it, that’s great.
“But if it’ll kick-start the next path in the medical field, then I’m all for it.”
The progress observed in his eye has been deemed “exceptional” by Bruce E. Gelb, MD, a transplant surgeon at New York University.
The transplant involved a single male donor in his 30s, and during the surgery, adult stem cells from the donor’s bone marrow were injected into the optic nerve to facilitate repair.
– ‘Huge deal’ –
“This is a huge deal,” Kia Washington, a professor of surgery at University of Colorado Anschutz Medical Campus, who has been working in the same field for 15 years, said, commending her peers.
Daniel Pelaez of the University of Miami’s Bascom Palmer Eye Institute, who has also been working towards the same goal, said, “The transplantation of a human eye at NYU Langone represents a pivotal moment in our common quest to restore sight and offers hope to countless individuals around the world.”
James, whose right eye remains intact, was considered an ideal candidate because his need for a facial transplant meant he would require immunosuppressive drugs regardless. This meant attempting an eye transplant would be worthwhile even if it conferred only cosmetic value.
“I can smell again, I can eat again, taste food. For the first time in a year and a half, I got to kiss my wife,” he said in an interview. “I want to go out in public now and not wear a mask and cover up.”
“I want it to get out to as many people as we can who may not know about this option — especially about the eye,” he continued.
“Even if it didn’t work for me, it was a start, so maybe Dr Rodriguez could learn something different to do the next time.”
– Optic nerve regeneration –
Given the time that has passed since the surgery, Washington said she did not think it likely that James’s eye would regain vision, but “I never say something is impossible,” she added.
The NYU Langone team said they had used bone marrow-derived adult stem cells from the donor to promote the nerve repair.
Achieving the goal of sight restoration could involve bringing other cutting-edge approaches to bear, said Washington — including gene therapy to tap the optic nerve’s intrinsic ability to heal; using a device called a nerve wrap to protect the tissue; or using devices that pick up signals and bypass the damaged pathway.
“We’re making great progress in the treatments to promote optic nerve regeneration that could accompany eye transplant,” Jeffrey Goldberg, who is leading similar efforts at the Byers Eye Institute at Stanford University, said.
“These adjunctive therapies will allow the donor eye to significantly connect to the brain and restore meaningful visual function to blind patients everywhere.”
Monitoring of James’s condition will continue.
