World's First Combined Face and Whole Eye Transplant Expands Reconstructive Options
Procedure improves appearance, function and quality of life, although vision was not restored

The first combined face and whole eye transplant shows surgeons can address traumatic facial and eye injuries once considered beyond the limits of conventional reconstruction, according to a study in the August issue of Plastic and Reconstructive Surgery®, which has been in publication for 80 years, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"The goal of this procedure was not to restore vision," said study author Sachin R. Chinta, MD, of NYU Langone Health in New York, New York. "People with severe facial and eye injuries can oftentimes feel not included in the comings and goings of regular society. They can feel somewhat isolated. They oftentimes don't associate the injured version of themselves with them being who they truly are."

A first step, not a vision cure

The patient, Aaron James, 46, sustained severe electrical burn injuries while working as a lineman in Arkansas. His injuries included his face and left eye.

"The current was devastating," said Dr. Chinta. "It was thousands and thousands of volts. He ended up with extensive burn injuries to his face and upper body."

Doctors determined that his injuries were beyond the limits of standard reconstruction and recommended him for combined face and whole eye transplantation. The study reports that the transplanted eye remains healthy. Vision has not been restored, but the patient experienced significant improvement in facial appearance and function.

Why the eye matters

Reconstruction is not only about appearance for patients with severe facial and eye trauma. Injuries may affect eating, speaking, social confidence and self-esteem. Dr. Chinta said a living eye provides a more natural aesthetic result than a prosthetic eye for patients, even when sight is not recovered.

"Aaron looked at his new eye and mentioned that this is the first time that he really felt like he was himself since before the injury," Dr. Chinta said.

Planning made the procedure possible

A team of multidisciplinary surgeons, including plastic surgeons, craniofacial surgeons, microsurgeons and a craniofacial orthodontist, along with hundreds of support staff, worked for two and a half years and performed 21 practice surgeries before the operation. The transplant took 21 hours total, the shortest transplantation done at NYU Langone Health.

"This procedure shows it is possible and able to be done in a safe and effective way," said Dr. Chinta.

The study notes that whole eye transplantation has been studied for decades. Surgeons have been working for almost 50 years to make it a reality. This case provides a framework for future research and gives reconstructive surgeons another possible option for patients with severe facial and eye injuries.

"While at times it may feel hopeless, hopefully procedures like this can provide patients with some level of hope," said Dr. Chinta. "The problem of blindness and being able to restore a patient's vision across the world is a huge burden on the healthcare system. The ultimate goal, of course, is being able to do these transplantation procedures and offer that ability to restore vision for millions of patients around the world."

The study demonstrates complex reconstruction can help patients regain function, confidence and a sense of self.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Logistical, Ethical, and Technical Considerations in the World's First Face and Whole Eye Transplantation"

Article: "Logistical, Ethical, and Technical Considerations in the World's First Face and Whole Eye Transplantation" (doi: 10.1097/PRS.0000000000012775)