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Total Human Eye Allotransplantation From Experimental Model To Clinical Reality
Kia M. Washington, MD1, Yang Li, MD, PhD1, Chiaki Komatsu, MD1, Edward H. Davidson, MA, MBBS1, Maxine R. Miller, MD1, Bo Wang, BS2, LiWei Dong, MD1, Lin He, MD1, Yolandi van de Merwe, BA1, Leon Ho, BA1, Mario G. Solari, MD1, Eric W. Wang, MD1, Vijay S. Gorantla, MD, PhD1, Dawn J. Wang, MD1, Jenny Y. Yu, MD1, Juan C. Fernandez-Miranda, MD1, Joel S. Schuman, MD1, Kevin C. Chan, PhD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
PURPOSE
Development of a reliable animal model for testing immunomodulation and neuroregeneration strategies, as well as development of human surgical protocols are vital in realizing eye transplantation.
METHODS
Syngeneic orthotopic transplants were performed in Lewis rats (n=20). Anastomoses between common carotid arteries and external jugular veins, and optic nerve coaptation were performed. Slit lamp examination, optical coherence tomography, histology and MRI confirmed structural integrity, viability, and aqueous humor dynamics. Human cadaveric heads (n=8) donor procurement involved an orbital, endonasal and transcranial approach. Sequential arterial and venous anastomoses and cranial nerve II-VI coaptations to recipients were performed.
RESULTS
Rat survival was 75%(15/20), graft survival 87%(13/15), mean ischemia time 1.98 hours, mean donor 1.15 hours, mean recipient 2.28 hours. Slit lamp, histology, and OCT revealed structural integrity. There was retinal blood flow, normal blood-aqueous, and blood-retinal barriers. Transplants had normal intraocular pressures.
Feasibility of cadaveric transplantation was established. Mean donor ophthalmic artery length and caliber were 13.5 and 1mm but with a stem of paraclival internal carotid artery were 33 and 2mm. Mean optic nerve length was 25mm from apex to annulus of Zinn and 14mm from annulus of Zinn to chiasm. Cranial nerves III-VI lengths were 10-14mm. Candidate recipient vessels required vein grafting.
CONCLUSIONS
This animal model and surgical protocol serve as a benchmark for ongoing investigation, ultimately potentiating the possibility of vision restoration transplantation surgery. 
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