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 transplantation was presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California. Their achievement demonstrates the feasibility of transplanting an entire eye alongside a face transplant.

This operation, performed in 2023, showcases the potential for future eye transplant procedures and marks a significant advancement in vascularized composite allotransplantation (VCA).

This type of transplantation is particularly challenging since, unlike organ transplants that involve just one type of tissue, like a kidney or heart, VCA involves transplanting a complex combination of different tissues—skin, muscle, blood vessels, nerves, and sometimes bone—all 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 medical professionals. The transplant was performed on Aaron James, a 46-year-old military veteran from Arkansas, who suffered extensive facial and eye injuries from a high-voltage electrical accident.

According to the researchers, the primary goal was to ensure the transplanted eye remained viable, and the innovative techniques used were critical to achieving that outcome. The team focused on optimizing blood flow, a key factor for 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 used nearby blood vessels, specifically the superficial temporal artery and vein, which were rotated to connect to the transplanted eye’s ophthalmic artery and vein. This innovative approach minimized retinal ischemia (loss of blood flow) and simultaneously restored blood flow to the face and eye, addressing a major challenge in eye transplantation.

Key surgical achievements

• Reduced ischemia: The bypass technique shortened the time without blood flow, protecting the transplanted eye.
• Enhanced blood flow: Post-surgery tests confirmed strong blood flow to the retina and other critical areas.
• Surgical precision: Customized cutting guides ensured precise alignment and preserved the intricate structures of the eye and surrounding tissue.

“The successful transplantation of a face and 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, department of surgery, at NYU Grossman School of Medicine.

“Aaron James, the patient, was made aware that while sight restoration was not the goal, maintaining a healthy, vascularized eye represented a critical breakthrough that could significantly impact the feasibility of similar procedures in the future.”