Sensational face and full eye transplant: one year later.

This operation, performed in 2023, showcases the potential for future eye transplant procedures and marks a significant advancement in the field of vascularized composite allotransplantation (VCA). This type of transplantation is particularly complex, as it involves the transfer of a sophisticated combination of various tissues — skin, muscles, blood vessels, nerves, and sometimes even bone — all within a single fragment, unlike organ transplantation, which typically involves only one type of tissue, such as a kidney or heart.

Under the guidance of Eduardo D. Rodriguez, a physician and member of the International Federation of Surgery, and the director of the face transplant program at NYU Langone Health, the operation was conducted by a multidisciplinary team of over 140 medical specialists. The transplantation was performed on a 46-year-old military veteran from Arkansas, who sustained extensive facial and eye injuries due to a high-voltage electrical accident. Face and eye transplantation utilized tissues from an immunologically compatible donor and standard immunosuppression protocols.

According to the researchers, the primary challenge was to ensure the viability of the transplanted eye, and to achieve this goal, fundamentally new methods were employed. The team focused on optimizing blood flow, which is a key factor for the long-term success of such a complex transplant.

To maintain blood flow in the transplanted eye, the team developed a microvascular bypass technique. Nearby blood vessels, specifically the temporal artery and vein, were redirected and connected to the eye artery and vein of the transplanted eye. This innovative approach minimized retinal ischemia (loss of blood flow) while simultaneously restoring blood supply to the face and eye, addressing the primary challenge of eye transplantation.

Key Surgical Achievements:

• reduction of ischemia: the bypass reduced the duration of blood flow absence, protecting the transplanted eye;

• enhanced blood flow: postoperative studies confirmed good blood supply to the retina and other critical areas;
• surgical precision: custom cutting guides ensured accurate alignment and preserved the intricate structure of the eye and surrounding tissues.

The successful transplantation of the face and entire eye demonstrated that with proper surgical techniques, the transplantation of a whole eye is indeed feasible and can be maintained over an extended period. The patient understood that the primary goal was not the complete restoration of vision, but rather the preservation of a healthy, vascularized eye.

Notably, the patient regained a retinal response to light, but one year after the transplantation, light perception in the transplanted eye was absent.

This type of operation represents an extremely important breakthrough that could significantly impact the possibility of conducting similar procedures in the future.