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

Abstract

Traumatic facial injury and resultant eye enucleation remains a devastatinglife-changing event for many. With advancements in surgical techniques andimmunosuppressive therapies, facial transplantation has been made viable.However, whole-eye transplantation (WET) has remained a distant goaluntil recently. Our aim was to review the existing literature on WET andassess current hurdles for its success. We identified pertinent keywords byconducting an initial literature exploration which was subsequently used tosearch scientific databases, including PubMed, Medline, and Embase. In linewith the narrative methodology employed in this article, specific inclusionand exclusion criteria were not explicitly defined. The review focused exclusivelyon articles relating to ocular restoration and reconstructive surgery.Though vision restoration remains elusive, burgeoning surgical techniquessuch as vascularised composite allotransplantation have openedthe scope for surgeons to consider WET when planning facial transplants.Dr. Rodriguez and the NYU Langone team’s transplantationhas remained viable at 10 months. Though it has not facilitated visualrestoration, it supports the potential of CD34-positive stem cells as neuroprotectiveagents when injected at the optic nerve connection of therecipient. Nevertheless, it is also crucial to deliberate on ethical considerationssuch as the lifelong implications associated with immunosuppressionand, challenges related to the equitable division of ocular tissue forWET versus keratoplasty. WET amid significant facial trauma has greatpotential to restore the quality of life in patients through improved cosmesis.Further research is required to demonstrate its long-term viabilityand potential for vision-restoration in humans.