Whole eye transplantation: are we on the cusp of an inflection point?

Abstract

Traumatic facial injury and resultant eye enucleation remains a devastating
life-changing event for many. With advancements in surgical techniques and
immunosuppressive therapies, facial transplantation has been made viable.
However, whole-eye transplantation (WET) has remained a distant goal
until recently. Our aim was to review the existing literature on WET and
assess current hurdles for its success. We identified pertinent keywords by
conducting an initial literature exploration which was subsequently used to
search scientific databases, including PubMed, Medline, and Embase. In line
with the narrative methodology employed in this article, specific inclusion
and exclusion criteria were not explicitly defined. The review focused exclusively
on articles relating to ocular restoration and reconstructive surgery.
Though vision restoration remains elusive, burgeoning surgical techniques
such as vascularised composite allotransplantation have opened
the scope for surgeons to consider WET when planning facial transplants.
Dr. Rodriguez and the NYU Langone team’s transplantation
has remained viable at 10 months. Though it has not facilitated visual
restoration, it supports the potential of CD34-positive stem cells as neuroprotective
agents when injected at the optic nerve connection of the
recipient. Nevertheless, it is also crucial to deliberate on ethical considerations
such as the lifelong implications associated with immunosuppression
and, challenges related to the equitable division of ocular tissue for
WET versus keratoplasty. WET amid significant facial trauma has great
potential to restore the quality of life in patients through improved cosmesis.
Further research is required to demonstrate its long-term viability
and potential for vision-restoration in humans.