This May, doctors at NYU Langone Health performed the first ever whole-eye transplant in history. It’s still not clear if the patient – a veteran who survived a high-voltage electrical incident – will regain his eyesight, but the eye has already shown “remarkable” signs of health.
These signs include direct blood flow to the retina, an area at the back of the eye that sends images to the brain.
“Although many questions remain in a case with no precedence, this groundbreaking achievement opens new possibilities for future advancements in vision therapies and related medical fields,” said a press release from the hospital.
Aaron James, 46, of Hot Springs, Ark., survived a potentially deadly 7,200-volt electric shock while working as a high-voltage lineman in June 2021. A live wire accidentally touched his face, leading to the loss of his nose, lips, front teeth, left cheek, chin, and his dominant arm from the elbow down.
Around two months after the injury, James’ case was introduced to the NYU Langone team.
“The possibility of a face transplant was discussed over the next year, and an initial evaluation for the transplant took place one year following the initial injury in June 2022,” said the hospital.
James’ left eye was removed by surgeons in Texas due to severe pain, but doctors recommended that his optic nerve be cut close to his eyeball to allow for reconstructive options. That’s when they started discussing including an eye as part of the transplant, although it had never been attempted before.
Corneal transplants are common in the U.S., but whole-eye transplants have remained elusive. According to NYU Langone, the complex nature of the eye, challenges associated with nerve regeneration in the area, immune rejection and blood flow to the retina are all issues that make whole-eye transplants a difficult procedure.
“Given Aaron needed a face transplant and will be taking immunosuppressive drugs regardless, the risk versus reward ratio of transplanting the eye was very low. Despite the eye being successfully transplanted, from a cosmetic standpoint, it would still be a remarkable achievement,” said Dr. Eduardo Rodriguez, leader of the team who worked on James’ surgery. This was the fifth face transplant completed under his leadership.
This May, a 30-year-old male donor was identified and plans for the surgery moved forward. It lasted for approximately 21 hours on May 27 and included a team of 140 surgeons, nurses, and other healthcare professionals.
“This is the first attempt of injecting adult stem cells into a human optic nerve during a transplant in the hopes of enhancing nerve regeneration,” said Samer Al-Homsi, executive director of the Transplantation and Cellular Therapy Center and professor in the Department of Medicine at NYU Langone. “We chose to use CD34-positive stem cells which have been shown to harbor the potential to replace damaged cells and neuroprotective properties.”
Bone marrow that was harvested from the donor’s vertebrae and processed preoperatively to isolate the CD34-positive stem cells was injected into James’ optic nerve connection during the surgery.
“We have now demonstrated that the procedure is safe and potentially efficacious, but we need time to determine if this step plays a role in enhancing the chance of sight restoration and if there’s anything further that can be done in the future to optimize the procedure,” said Al-Homsi.
Going forward, doctors will continue to monitor James’ transplanted eye with various clinical tests, including electroretinography, a test that measures the electrical response of the retina to light.
In the James household the patient is looking forward to celebrating Thanksgiving with his wife and daughter, CNN reported. He can smell and taste now, so he’s especially looking forward to enjoying the holiday dinner.