Over a year ago, a surgical team at NYU Langone Health performed the world’s first whole-eye and partial-face transplant for military veteran Aaron James. He had survived a high-voltage electrical accident at work in 2021 when his face touched a live wire. Despite undergoing many reconstructive surgeries, James still had injuries, including the loss of his left eye, left arm from the elbow, nose, lips, front teeth, left cheek, and chin. Despite all of this, James, 46, has made remarkable progress and has resumed his daily life in Arkansas.
The NYU Langone team was first introduced to Aaron’s case two months after his injury, taking guidance from a Texas medical center that was providing him early-phase reconstruction care. The possibility of a face transplant was discussed over the course of a year, but when Texas surgeons were forced to remove James’ left eye due to severe pain, the discussion of the possibility of an eye transplant along with a face transplant, something that had never been tried before.
In a study published in the Journal of the American Medical Association, clinical outcomes from this case have been reported. The donor eye maintained normal pressure and blood flow over the past year, even though many animal models of whole-eye transplants indicated otherwise. Although Aaron’s new eye has not yet restored his vision, there is still hope. An electroretinography—a test that measures the retina’s electrical response to light—shows that the eye has some photoreceptor response. This means that the rods, cones, and nerve cells in the eye all survived the transplant.
“Our discoveries over the past year mark promising initial results, laying a foundation for further advancements and ongoing research,” said Eduardo D. Rodriguez, MD, DDS, the senior author of the study and the surgeon who led a team of more than 140 medical professionals who collaborated on the procedure. “We are truly amazed by Aaron’s recovery, with no episodes of rejection”.
The surgery lasted 21 hours and involved microsurgical techniques, customized surgical devices, and cell-based therapies. This procedure was also the first attempt at injecting stem cells into a human optic nerve during a transplant. The goal was to enhance nerve regeneration for James post-surgery. Dr. Rodriguez and his colleagues from Hansjörg Wyss Department of Plastic Surgery, the Departments of Ophthalmology and Radiology, and NYU Langone’s Transplant Institute worked together to ensure that Aaron received the best possible outcome. It seems that their hard work and dedication have led to the scientific breakthrough the community sees a year later.
As for James, this year has been marked by many milestones – he notes that he does not take anything for granted and looks forward to what matters most in his life. “I have felt honored to be patient zero. Even if I can’t see out of my new eye, I’ve gained my quality of life back, and I know this is a step forward in the path to help future patients,” said James.
Vision loss is something that over seven million Americans struggle with. While there are many methods to minimize the progression of sight loss, nothing can currently restore a person’s vision. Up until now, whole-eye transplants have remained too complex for execution due to numerous difficulties. Surgical teams must ensure they maintain blood flow, prevent immune rejection, preserve the eye’s response to light, and ensure that nerve connections to the brain regrow so that proper signaling occurs.
“We’ve done the work to transplant an eye. We now need to do more work in understanding how to restore sight to the eye,” said Dr. Rodriguez. “We look forward to continuing this research in collaboration across academia to accelerate these discoveries with unique tools and the best therapies.”
