American Association of Plastic Surgeons

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The World’s First Successful Combined Face And Whole Eye Transplant
David L. Tran, MD1, Alay R. Shah, MD1, Sachin R. Chinta, BS1, Vaidehi S. Dedania, MD1, Bruce E. Gelb, MD1, Daniel J. Ceradini, MD2, Eduardo D. Rodriguez, MD DDS1.
1New York University Langone Health, New York, NY, USA, 2New York University Langone Health, New York City, NY, USA.

PURPOSE:Previous attempts at whole eye transplantation (WET) were ultimately deemed unsuccessful due to both technical and immunologic limitations. Since the first face transplant (FT) in 2005, significant strides have been made in our understanding of both, with multiple groups establishing technical feasibility of FT. Coinciding with these achievements, an improved understanding of immunologic processes and rejection affords the opportunity to revisit WET.
METHODS:We report a 46-year-old male who sustained a high voltage electrical injury resulting in severe facial injuries and left eye enucleation, who received a combined partial face and whole eye transplant with optic nerve coaptation and induction via rituximab and anti-thymoglobulin.
RESULTS:More than 100 days postoperatively, no evidence of acute rejection of the allograft has been observed. Evaluation of the face and imaging of the eye demonstrates robust vascular perfusion to the face, choroid, and retina via the external carotid artery. Clinical assessment demonstrates a normal appearing transplanted eye with normal intraocular pressure. Anatomic imaging demonstrates retinal cell layer integrity and persistent laminar arrangement with a visible photoreceptor layer. Functional evaluation of the transplanted eye demonstrates measurable electrical response in response to light stimulus at the level of the retina. fMRI demonstrates corresponding cortical activity at the visual cortex.
CONCLUSION:The successful execution of a WET represents a remarkable achievement in the field of VCA. We provide details regarding the clinical success of the world’s first combined face and eye transplant for reconstruction of a high voltage electrical injury using both anatomical and functional imaging.
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