Innovative Eye Transplant Success: Unprecedented Breakthrough at NYU Langone Health

2023-11-09 20:54:25

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An accident with power lines had destroyed most of Aaron James’ face. His right eye still works. But surgeons at NYU Langone Health hoped that replacing the missing eye would provide better cosmetic results for her new face, supporting the transplanted eye socket and eyelid.

The New York University team announced Thursday that this has been the case so far. Mr. James is recovering well from the double transplant performed last May and the donated eye appears remarkably healthy.

“I feel good. I don’t have any movement yet. I can’t blink yet. But I have feeling now,” Mr. James told The Associated Press as doctors recently reviewed his progress.

“You have to start somewhere, there has to be a first person somewhere,” added the 46-year-old, living in Hot Springs, Arkansas. Maybe you’ll learn something from it that will help the next person.”

Today, corneal transplants — the clear tissue at the front of the eye — are common to treat some vision loss. But transplanting the entire eye — the eyeball, its blood supply and the essential optic nerve that must connect it to the brain — is considered a major breakthrough in the quest to cure blindness.

Whatever happens next, Mr. James’s operation offers scientists an unprecedented window into how the human eye attempts to heal.

“We are not claiming that we are going to put an end to the loss of sight,” qualified Dr. Eduardo Rodriguez, head of the plastic surgery department at New York University, who led the transplant. “But there is no doubt in my mind that we have taken a step forward.”

Some specialists had feared that the eye would quickly shrivel like a raisin. Instead, when Rodriguez opened James’ left eyelid last month, the donated eye, hazel in color, was as swollen and full of fluid as his own blue eye. Doctors noted good blood circulation and no signs of rejection.

Researchers began analyzing scans of James’ brain, which detected strange signals coming from the important but injured optic nerve.

A scientist who has long studied how to make eye transplants a reality described the operation as exciting.

Jeffrey Goldberg, chairman of the Department of Ophthalmology at Stanford University, said: “This is a stunning validation of animal experiments that have kept transplanted eyes alive.”

The obstacle is how to regrow the optic nerve, although animal studies are making strides, Goldberg added. He praised the “audacity” of the New York University team, which even sought to repair the optic nerve, and hopes the transplant will encourage further research.

“We’re really close to being able to do this,” Mr. Goldberg added.

Mr James was working for a power lines company in June 2021 when he was electrocuted by a live wire. He almost died. He eventually lost his left arm, requiring him to wear a prosthetic. His damaged left eye was so painful it had to be removed. Multiple reconstructive surgeries failed to repair his extensive facial injuries, including his missing nose and lips.

Mr. James underwent physical therapy until he was strong enough to accompany his daughter Allie to her high school graduation, complete with a mask and eye patch. He still needed a breathing tube and a feeding tube, and longed to smell, taste and eat solid food once more.

“In his mind and in his heart, that’s him, so I didn’t care that he didn’t have a nose. But what mattered to me was that it bothered him,” said his wife, Meagan James.

Face transplants remain rare and risky. James’s is only the 19th in the United States and the fifth made by Rodriguez. The eye experiment added even more complexity. But Mr. James figured he wouldn’t be any worse off if the donated eye failed.

Three months following James was placed on the national transplant waiting list, a suitable donor was found. The kidneys, liver and pancreas of the donor, a man in his thirties, saved three other people.

During James’ 21-hour operation, surgeons added another experimental element: When they connected the donated optic nerve to what remained of James’ original nerve, they injected special stem cells from the donor into the hope of stimulating its repair.

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