First complete eye transplant in the United States – without vision restoration – 11/09/2023 at 9:34 PM

Dr. Eduardo Rodriguez of NYU Langone Health operates on Aaron James during the first complete eye transplant performed on a human patient, in New York in May 2023 (NYU Langone Health / Joe CARROTTA)

In a world first that offers hope for people who have lost the use of one eye: American surgeons announced Thursday that they had performed the first complete eye transplant on a patient, who, however, did not restore sight – at least for the time being.

Just over five months after surgery, the patient’s eye continues to show signs of very good health, including blood flow to the retina. Results that leave experts “stunned,” said Dr. Eduardo Rodriguez, who led the proceedings, at a news conference.

“There are millions of people who have lost their sight, and we’re not saying we’re going to fix this today,” the surgeon said. “But we are certainly a bit closer.”

The surgery took about 21 hours and was performed in late May by a team from NYU Langone Health University Hospital in New York.

In addition to the left eye and eye socket, surgeons also transplanted a donor’s nose, lips and other facial tissue.

The receiving patient, Aaron James, suffered a work accident in 2021 that could have cost him his life, when his face struck a power line.

Since he had to take immunosuppressants anyway to prevent rejection of the grafts placed on his face, this former soldier was an ideal candidate to perform an eye transplant.

– “Huge progress” –

Aaron James, whose right eye is still functioning normally, appeared at the press conference with his face completely uncovered, his left eye closed under his eyelid (which he cannot yet move naturally).

“Whether I can see it or not, that’s the way it is,” he said, thanking the donor and his family. “You have to start somewhere, and I hope this sets in motion something that we can improve for the next patient.”

“I can smell and eat again,” he told AFP, adding that he wanted to “go out in public again.” “For the first time in a year and a half, I was able to kiss my wife.”

Could it be that the transplanted eye can then see again?

Aaron James, who received the first complete eye transplant, and his wife in New York after the surgery, in a photo provided by NYU Langone Health (NYU Langone Health/Handout)

“In medicine, you never like to say never,” replied Vaidehi Dedania, a retina specialist at NYU Langone Health. “We’ll continue to monitor it and see how things evolve. But we have a lot of hope.”

“A large part of the retina has been preserved and our tests show that it is capable of generating a signal,” she explains.

The doctors did not expect such good results and a team was urgently formed to explore the different avenues that could help restore vision.

Aaron James, realizing that this surgery could only have an aesthetic benefit for him, has now been able to live with his wife and daughter in Arkansas, returning to New York every month for appointments.

This is a “remarkable achievement” that marks an important step toward “the ultimate goal of restoring vision,” said AFP Daniel Pelaez, associate professor of ophthalmology at the University of Miami.

“This is a huge step forward,” said surgeon Kia Washington, who has been working on this problem for a decade at the University of Colorado. “So many people still doubted” that such a transplant “was possible in humans.”

– Nerve connection –

The biggest difficulty with an eye transplant is restoring the transmission of information to the brain via the optic nerve. This is essentially cut on both the patient and the donor to perform the graft.

In the past, whole eye transplants had been performed on small animals, with vision being at least partially restored in some cases, explains surgeon Kia Washington.

But to achieve this in people, she says, it will take combining “many different methods”. Among those mentioned by the specialist as future possibilities: gene therapy, the use of stem cells or even the preparation of the recipient’s brain through electrical stimulation.

In the case of Aaron James, stem cells from the donor’s spinal cord were also injected into the patient’s optic nerve, in the hope of improving its regeneration.

Will it one day be possible to restore sight through a transplant to someone who has been blind from birth? This is still a distant horizon, answers Kia Washington. But “I think it will happen in the coming decades.”

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