Innovative surgical technique makes combined face and whole eye transplantation a reality

An explanation of how an NYU Langone Health surgical team performed the world’s first combined face and whole eye transplant was presented at the 2024 American College of Surgeons (ACS) Clinical Congress in San Francisco, California. Their achievement demonstrates the feasibility of transplanting an entire eye alongside a face transplant.

This operation, performed in 2023, demonstrates the potential of future eye transplantation procedures and marks a significant advance in vascularized composite allotransplantation (VCA).

This type of transplantation is particularly difficult because, unlike organ transplants that involve a single type of tissue, such as a kidney or a heart, stroke involves the transplantation of a complex combination of different tissues (skin, muscles, blood vessels). blood, nerves and sometimes bones). in one piece.

Led by Eduardo D. Rodriguez, MD, FACS, director of the Face Transplant Program at NYU Langone Health, the surgery involved a multidisciplinary team of more than 140 healthcare professionals. The transplant was performed on Aaron James, a 46-year-old military veteran from Arkansas, who suffered severe facial and eye injuries following a high-voltage electrical accident.

According to the researchers, the main goal was to ensure the viability of the transplanted eye, and the innovative techniques used were essential to achieve this result. The team focused on optimizing blood flow, a key factor in the long-term success of such a complex transplant.

The team developed a microvascular bypass technique to maintain blood flow to the transplanted eye. This bypass utilized nearby blood vessels, particularly the superficial temporal artery and vein, which were rotated to connect to the ophthalmic artery and vein of the transplanted eye. This innovative approach minimized retinal ischemia (loss of blood flow) and simultaneously restored blood flow to the face and eyes, addressing a major challenge in eye transplantation.

Main surgical achievements

• Reduced ischemia: The bypass technique reduced the time without blood flow, thereby protecting the transplanted eye.
• Improved blood flow: Post-operative tests confirmed strong blood flow to the retina and other critical areas.
• Surgical Precision: Custom cutting guides ensure precise alignment and preserve the complex structures of the eye and surrounding tissues.

“The successful transplant of a face and a whole eye demonstrated that with the right surgical techniques, a whole eye transplant is feasible and can maintain long-term viability,” said Bruce E. Gelb, MD, FACS, associate professor in the Department of Surgery. , at NYU Grossman School of Medicine.

“Aaron James, the patient, was informed that although restoring vision was not the goal, maintaining a healthy, vascularized eye represented a crucial advancement that could have a significant impact on the feasibility of procedures similar in the future.”