By Linda Conlin, Pro to Pro Managing Editor

On November 9, NYU Langone Health announced the world’s first whole-eye and partial-face transplant for a 46-year-old military veteran from Arkansas who survived a work-related high-voltage electrical accident in June 2021. The surgery included transplanting the entire left eye and a portion of the face from a single donor, making this the first-ever human whole-eye transplant in medical history and the only successful combined transplant case of its kind. While it is still unknown whether he will regain sight, since the May 2023 procedure, the transplanted left eye has shown remarkable signs of health, including direct blood flow to the retina. (https://nyulangone.org/news/nyu-langone-health-performs-worlds-first-whole-eye-partial-face-transplant)

The surgery, nearly two years after the accident and loss of the eye, lasted approximately 21 hours, and included a team of more than 140 surgeons, nurses, and other healthcare professionals, led by Dr. Eduardo D. Rodriguez. The transplant consisted of partial face, including the nose, left upper and lower eyelids, left eyebrow, upper and lower lips, and underlying skull, cheek, nasal, and chin bone segments, with all of the tissues below the right eye including the underlying muscles, blood vessels, and nerves, left whole eye and socket including the orbital bones and all surrounding eye tissues including the optic nerve. The surgery combined the donor eye with donor bone marrow–derived adult stem cells, which divide to create heathy cells that replace the damaged or dysfunctional elements, in what is the first attempt of injecting adult stem cells into a human optic nerve during a transplant.

In a recent progress examination, patient Aaron James reported that while he can’t blink yet or move the eye and wears a patch for protection, he has some sensation. Dr. Rodriguez, however, detected some movement in the eye muscles. NYU ophthalmologist Dr. Vaidehi Dedania ran a battery of tests and found expected damage in the retina, but she said it appears to have enough photoreceptors that respond to light for a step toward vision. What’s more, brain scans seem to indicate some signals from the optic nerve. (https://www.npr.org/2023/11/10/1212067302/arkansas-man-receives-the-worlds-first-whole-eye-transplant-plus-a-new-face)

James’ progress has exceeded doctors’ expectations. “What we’re witnessing now is not something we ever expected or thought we’d see,” said Dr. Dedania, who runs regular tests for James’ eyes. “The progress we’ve seen with the eye is exceptional, especially considering that we have a viable cornea paired with a retina showing great blood flow five months after the procedure. This far exceeds our initial expectations, given our initial hope was that the eye would survive at least 90 days,” said Bruce E. Gelb, MD, a transplant surgeon at the NYU Langone Transplant Institute. While James understands that he may not regain vision in the transplanted eye, he hopes that his story can serve as inspiration for those facing severe facial and ocular injuries. “That’s really my biggest hope,” he 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.”