In May 2023, surgeons transplanted an entire eye and parts of the face into a seriously injured person for the first time. The team is now reporting on the patient’s progress within the first year after the operation. According to the report, the eye continues to receive blood and has normal eye pressure. Even the photoreceptors react to light. However, the connection to the patient’s brain does not work, so he is still blind in the transplanted eye.
Aaron James, a 46-year-old American, is the first person in the world to live with a transplanted eye. In June 2021, he lost parts of his face, an eye and his left arm in an accident at work involving a high-voltage cable. In May 2023, surgeons reconstructed his face and transplanted a complete donor eye. They connected the eye’s blood vessels to those of the patient and injected stem cells into the optic nerve to stimulate the regeneration of the connection between the eye and the brain.
Maintain important functions
Now the team led by plastic surgeon Daniel Ceradini of New York University Langone Health is reporting on the results of follow-up examinations in the first year after the transplant. “Although the recipient did not regain his vision, the transplanted eye retained normal pressure, good blood flow and some residual structures and functions in the retina,” reports Ceradini’s colleague Eduardo Rodriguez. “Many experts did not think we would even get this far, but we managed to transplant and preserve an eye without immune rejection.”
The vision of one day restoring sight to blind people through eye transplants is still a long way off. But the results show that it is possible in principle to transplant an entire eye while maintaining its basic functionality. So far, it has been possible to transplant the cornea of the eye and thus cure certain forms of blindness. However, transplanting an entire eye presents additional challenges, including maintaining blood flow in the retina, preventing rejection by the immune system, and maintaining the eye’s response to light. Aaron James has succeeded in all of these steps. What is still missing is a functional connection between the transplanted eye and the brain.
Basis for further research
“We have successfully worked to transplant an eye,” says Rodriguez. “Now we need to continue working to understand how we can restore vision to the eye.” The fact that the photoreceptors still respond to light one year after the transplant is a remarkable success, according to the researchers. “The results we see after this procedure are incredible and could pave the way for new clinical protocols and stimulate further research into complex transplants involving critical sensory organs,” says Ceradini’s colleague Vaidehi Dedania.
For Aaron James, the transplanted eye has only a cosmetic function, at least so far. He cannot see with the eye, cannot move it, and cannot open the eyelid. But the mere fact of having two eyes again and a face that is not completely disfigured is of great importance to James. “The aesthetic results and quality of life that Aaron has gained through this procedure should not be overshadowed,” says Ceradini. “He has regained many elements of life that he had lost after the injury in 2021, and that is our ultimate goal.”
Source: Daniel Ceradini (NYU Langone Health, New York, USA) et al.; JAMA, doi: 10.1001/jama.2024.12601