World's first combined whole eye, face transplant at NYU called success

NEW YORK, Sept. 9 (UPI) -- A patient who underwent the world's first whole-eye and partial-face transplant has healed astonishingly well more than a year after the 21-hour surgery, a new report says.

The report of the surgery , conducted at NYU Langone Health in New York City, appeared Monday in the Journal of the American Medical Association.

Researchers hailed the results as remarkable because helping people with catastrophic facial injuries that include eyeball loss has presented a daunting challenge even for surgeons at the nation's leading academic medical centers.

"The procedure was a success," the study's lead author, Dr. Daniel Ceradini, director of research and associate professor in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health, told UPI in a telephone interview.

"This is the first of many significant hurdles to be crossed on our way to the restoration of sight with transplantation," Ceradini added.

So far, the transplanted donor eye has not reacquired the ability to see, but it continues to display normal pressure and blood flow. This is a notable improvement over whole-eye transplants in animals, where the eye often decreased dramatically in size, researchers noted.

"Getting blood supply to the eye has been a logistical hurdle previously," Ceradini said.

In addition, a test measuring the retina's electrical response to light revealed that the light-sensitive nerve cells in the eye survived the transplant, paving the way for whole-eye transplants with the goal of restoring sight.

A team of more than 140 doctors, nurses and other health professionals collaborated on the surgical procedure in May 2023 on Aaron James, a military veteran from Hot Springs Village, Ark., who was otherwise healthy.

In June 2021, James sustained severe injuries in a high-voltage electrical accident at his job as a lineman near Tulsa, Okla., and went into a coma for six weeks.

The tragedy led to the loss of his left eye, left eyelid, nose and lips, as well as a large volume of facial tissue including skin and muscles that control facial expressions.

After doctors removed the damaged eye, James said he felt that the whole-eye transplant, performed along with a partial-face transplant, would be worth attempting.

Doctors discussed the ethics of moving forward with the innovative procedure and the absence of data in large animal models to support optic nerve regrowth from a transplanted eye.

They also pointed out the potential risk of jeopardizing or losing vision to the other eye and the very low chance that the transplanted eye would have worthwhile vision, the study noted.

Even so, James, now 47, decided to proceed with the landmark surgery.

"With me trying this, even if it didn't work, the doctors were still going to learn some valuable information, so I was all for it," he told UPI. "If nothing else, it would help people down the road."

His doctors attribute the transplant's success to the matching process, which ensured that James received the most compatible donor, as well as NYU Langone Health's unique regimen of immunosuppressants -- medications that help prevent early rejection of new tissues.

"Nobody really knew what was going to happen," James said. "They honestly didn't expect the eye to survive. They didn't think it would make it. But here we are a year later, and the eye is still alive."

This study "greatly motivates the entire field to push forward on the critical pre-clinical research that will be needed to turn eye transplant into a vision restoring procedure," said Dr. Jeffrey Goldberg , a professor and chair of ophthalmology in the Byers Eye Institute at Stanford University in Palo Alto, Calif.

Goldberg, who was not involved in the study, wrote an editorial that accompanied the report.

"For almost three decades, I have been engaged in research on optic nerve generation, which is the central scientific challenge to getting eye transplant to a stage that it could restore vision for blind patients," he said.

In the editorial, Goldberg noted that bilateral blindness affects more than 40 million people on a global scale, including more than 1 million people in the United States. An even greater number of people have substantial vision impairments. Yet, he added, restorative therapies don't exist, so blindness is often irreversible.

The whole-eye transplant that James underwent is "opening a new era," said Dr. José-Alain Sahel, chair and distinguished professor in the department of ophthalmology at the University of Pittsburgh School of Medicine and director of the UPMC Vision Institute.

Surgeons were able to successfully connect tissues and blood vessels from the donor to the recipient, Sahel said, describing this feat as "a very important achievement," but that "there is a long way to go before useful vision is restored."

Enabling a patient to see out of a transplanted eye calls for more research into regeneration of the optic nerve. This long bundle of nerve fibers linking the eye to the brain doesn't regrow after being damaged, researchers explained.

"Of course, what one would want is the restoration of vision, and that's the toughest part," said Larry Benowitz, a professor emeritus of neurosurgery and ophthalmology at Harvard Medical School in Boston and a professor of ophthalmology at the University of Pittsburgh.

"This is really the goal that we would hope for, and there's a lot more work required," Benowitz, who has a doctorate in neurobiology said, noting that "what's needed is to be able to stimulate the nerve cells in the eye of the donor to grow their nerve fibers into the patient's brain."

For now, "the aesthetic outcome of this surgery is nothing short of remarkable," said Dr. Thomas Johnson, an associate professor of ophthalmology in the Wilmer Eye Institute at Johns Hopkins University in Baltimore.

"This is a major advance for the field because it's the first time that an eye has been transplanted and shown to have at least some of its tissues survive long term," Johnson said.

As for James, he added that "certainly, by undergoing the eye transplant procedure, he was contributing to the cutting edge of science, pushing the boundaries of what's possible."