In a significant stride towards restoring sight, a man has successfully undergone the first-ever eye transplant, and a brand new face.

Busy Bee
Busy Bee November 13, 2023
Updated 2023/11/13 at 12:29 PM

The medical world has reached a groundbreaking milestone with the inaugural complete human eye transplant, a significant advancement in the realm of facial transplants. However, it remains uncertain whether the recipient will regain vision through the newly transplanted left eye.

Aaron James suffered severe facial damage, including the loss of one eye, due to a high-voltage power line accident. While his right eye remains functional, the team at NYU Langone Health aimed to enhance the aesthetics of his reconstructed face by replacing the missing eye, offering structural support to the transplanted eye socket and eyelid.

In an update released by the NYU team, James, who underwent the dual transplant in May, is showing positive signs of recovery. His progress is promising, and the transplanted eye appears to be remarkably healthy.

Expressing his experience, James shared, “It feels good. I still don’t have any movement in it yet. My eyelid, I can’t blink yet. But I’m getting sensation now,” underscoring his ongoing improvement during recent medical evaluations.

“At some point, someone had to be the first. Maybe from this, something can be learned that will benefit others,” noted the 46-year-old from Hot Springs, Arkansas, highlighting the potential for advancements in future treatments.

While corneal transplants for specific vision impairments are relatively common today, the transplantation of an entire eye—comprising the eyeball, its blood supply, and the crucial optic nerve necessary for connection to the brain—is regarded as a groundbreaking endeavor in the pursuit of curing blindness.

No matter what unfolds next, James’ surgery provides scientists with an unprecedented opportunity to observe how the human eye attempts to heal.

“We’re not claiming we’ll restore sight,” stated Dr. Eduardo Rodriguez, NYU’s chief of plastic surgery who oversaw the transplant. “But I firmly believe we’ve moved a step closer.”

Some experts had anticipated the eye would rapidly shrink, but when Rodriguez revealed James’ left eyelid last month, the hazel-colored donated eye appeared as plump and filled with fluid as his own blue eye. Doctors are observing good blood flow and no signs of rejection.

Researchers have begun scrutinizing brain scans of James, revealing intriguing signals from the critical but damaged optic nerve.

A scientist deeply involved in eye transplant research hailed the surgery as thrilling. “It’s a remarkable validation,” stated Dr. Jeffrey Goldberg, chair of ophthalmology at Stanford University, referencing animal experiments that have sustained transplanted eyes. He acknowledged the challenge of regenerating the optic nerve, but he praised the NYU team’s bold approach and hoped the transplant would catalyze further exploration.

“We’re at the edge of being able to achieve this,” Goldberg remarked.

James suffered a severe injury while working for a power line company in June 2021, nearly losing his life. The accident resulted in the loss of his left arm, necessitating a prosthetic. His injured left eye was so agonizing it had to be removed. Despite multiple reconstructive surgeries to mend extensive facial damage, including a missing nose and lips, James persisted through physical therapy. His ultimate goal is to regain the ability to smell, taste, and eat solid food, while longing for a return to normalcy.

“In my heart and in my mind, he was still him—so I didn’t really mind that he didn’t have a nose. But it bothered him,” explained Meagan James, his wife.

Face transplants are incredibly rare and pose significant risks. James’ procedure marks only the 19th in the United States and the fifth performed by Dr. Rodriguez. The inclusion of an eye in the transplant made the process even more intricate, but James reasoned that the worst-case scenario would be no worse off if the transplanted eye didn’t function.

Three months after being added to the national transplant waiting list, a suitable donor was found. Organs from the donor, a man in his 30s, including kidneys, a liver, and a pancreas, saved three other lives.

During the extensive 21-hour operation, surgeons introduced an additional experimental approach: the donated optic nerve was fused to what remained of James’ original nerve, and special stem cells from the donor were injected to potentially facilitate nerve repair.

Recent sensations suggested the mending of facial nerves for James. Although he can’t yet open the eyelid and has to wear a protective patch, during an examination, Rodriguez applied pressure on the closed eye, and James felt a sensation—primarily on his nose instead of his eyelid, likely until the slow-growing nerves readjust. The surgeon also observed subtle muscle movements around the eye beginning.

Further examination by NYU ophthalmologist Dr. Vaidehi Dedania revealed some anticipated damage in the light-sensing retina at the back of the eye. However, there seems to be an adequate number of photoreceptor cells to convert light into electrical signals, a crucial step in visual perception.

Ordinarily, these signals are transmitted through the optic nerve to the brain for interpretation. Despite the fact that James’ optic nerve has not fully healed, an MRI scan showed brain activity when light was flashed into the transplanted eye.

This discovery both excited and puzzled researchers, although Dr. Steven Galetta, NYU’s neurology chair, cautioned that this brain signaling may not be suitable for vision and could potentially be a coincidental occurrence. Further analysis and time may provide more clarity.

Dr. David Klassen, chief medical officer of the United Network for Organ Sharing, hailed the surgery as a remarkable technical achievement. He emphasized the potential to learn an immense amount from a single transplant that could propel the field forward.

Regarding his progress, James stated, “We’re just taking it one day at a time.”

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