James' World 2

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In June of 2021, Aaron James experienced a terrible accident while working as an electrical lineman. The 46-year-old military veteran and Arkansas resident lost much of the left side of his face—including his left eye—to severely disfiguring electrical burns that also destroyed his left arm.

Two years later, James received the first-ever partial face and whole-eye transplant, performed by surgeons at NYU Langone Health in New York City. And now, more than a year after that, James has made a strong recovery with no evidence of tissue rejection, his medical team reported in a paper published on Monday in JAMA. He still lacks any vision in the transplanted eye, but the eye itself has maintained its shape and blood flow—and there is evidence of electrical activity in the retina in response to light.

Other researchers say the findings represent a step toward successful whole-eye transplants while illustrating the challenge of regenerating the optic nerve after a major injury.

“It’s a delightful surprise that the surgery has worked so well, that the patient is so happy, that the aesthetic or cosmetic outcome has worked so well. The eyeball itself has stayed alive and is able to stay in that space and can continue to contribute to the overall success of hemifacial transplant,” says Jeffrey Goldberg, a professor, and chair of ophthalmology at the Byers Eye Institute at Stanford University, who was not involved in the study but wrote a commentary on it that was published in the same issue of JAMA.

The lack of restored vision was not unexpected, Goldberg says, because preclinical studies in animals have shown the difficulty of regrowing an optic nerve. He notes that the surgical team’s technique of injecting the tissue surrounding the optic nerve with stem cells from James’s bone marrow has not been validated in animals and could pose a safety risk if the cells grew into a tumor. Fortunately, there is no evidence of this happening to date. Another risk was that if the donor eye’s optic nerve had regrown, it could have compromised the vision in James’s other eye because of the way input from the two eyes can interact in the brain. There is no sign of this complication either, however. This exciting first case helps lay the groundwork to push whole-eye transplant into a vision-restoring reality, Goldberg says.

Whole-eye transplants have long been a dream among doctors and scientists seeking to treat people with serious eye injuries or blindness. The first corneal transplant took place in 1905. But efforts to transplant an entire eye have been thwarted by the devilish difficulty of regrowing the optic nerve, which carries signals from the eye’s light-sensitive retina to the brain’s visual centers, where they are perceived as sight. While there had previously been limited success in efforts to regenerate the optic nerve in some animals, no one had succeeded in transplanting a whole eye into a human until now.

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