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Navigating the Unknown: Corneal Abrasion in the First Human Whole Eye Transplant
Hailey Paige Wyatt, MD, Alexis K. Gursky, BS, Alay R. Shah, MD, Sachin R. Chinta, BS, Sergio A. Segrera, MS, Anandhini D. Narayanan, MD, Bruce E. Gelb, MD, Daniel J. Ceradini, MD, Vaidehi S. Dedania, MD, Eduardo D. Rodriguez, MD.
New York University Langone Health, New York, NY, USA.
PURPOSE: Whole eye transplantation (WET) represents a novel frontier in vascularized composite allotransplantation (VCA) with only 1 human case successfully completed in May 2023. Due to the novelty of WET there is no standardized definition of acute rejection, and no established protocols for monitoring or management. We present the first case of a WET recipient who developed a mechanical corneal abrasion, with the subsequent clinical sequelae and management.
METHODS: A retrospective review was performed of a single patient who underwent the world’s first WET in May 2023. Ophthalmologic exams, cultures, treatments, and clinical course were analyzed.
RESULTS: In November 2024, the patient presented with redness and was found to have a mechanical corneal abrasion on the transplanted globe. Despite negative cultures, worsening inflammation prompted admission for intravenous antibiotics and fortified topical antibiotics, with gradual improvement. By December new conjunctival hyperemia and hypopyon raised concern for rejection. Tacrolimus drops were initiated with subsequent resolution of inflammation and scar formation on the cornea. At most recent follow-up, his ophthalmologic exam remains stable, with normal IOP, physiologic perfusion of the globe and near resolution of the corneal scar. Neither prior to nor during this event were there signs of clinical rejection of the rest of the facial allograft.
CONCLUSION: This case highlights the ability of an immunosuppressed, insensate, transplanted globe to heal in the setting of mechanical abrasion, complicated by suspected infection and possible acute rejection. Standardized protocols for rejection monitoring and management are needed to optimize outcomes in WET.
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