Combined Whole Eye and Face Transplant: Microsurgical Strategy and 1-Year Clinical Course

Area of Science:

• Ophthalmology
• Plastic Surgery
• Transplantation Immunology

Background:

• Catastrophic facial injury with globe loss presents significant reconstructive challenges.
• Current reconstructive options for complete eye loss are limited.
• Whole eye transplantation has not been previously reported in combination with facial transplantation.

Observation:

• A 46-year-old male with extensive facial and globe loss from electrical injury underwent combined whole eye and face transplant.
• A novel microsurgical strategy and personalized devices were employed.
• The procedure involved primary optic nerve coaptation and standard immunosuppression.

Findings:

• The transplanted eye and face allografts demonstrated successful reperfusion and viability.
• Fluorescein angiography confirmed globe and retinal perfusion.
• Optical coherence tomography showed inner retinal layer atrophy.
• Serial electroretinography indicated retinal responses to light stimuli.
• MRI confirmed the integrity of visual pathways and occipital cortical response.
• Despite these findings, the patient had no light perception at one year post-transplant.

Implications:

• This case represents the first successful whole eye and face allotransplantation.
• The study demonstrates allograft survival and rejection-free graft survival.
• Retinal function, though not restoring vision, shows potential for future globe allotransplantation.
• This research opens new avenues for treating severe facial and ocular trauma.