NYU Langone Hails Recovery of Man Over a Year after Landmark Whole Eye Transplant

A surgical team at NYU Langone Health performed the world’s first whole eye and partial-face transplant in May 2023 for Aaron James, who had survived a high-voltage electrical accident at work.

Over a year later, James has made a remarkable recovery and is back to daily life in Arkansas.

Although the transplanted eye has not regained vision, a study published Sept. 9 in the Journal of the American Medical Association (JAMA) reveals that it has maintained normal pressure and blood flow over time. Electroretinography shows a photoreceptor response to light, indicating that rods and cones survived the transplant.

Doctors at NYU Langone say the results give hope for the future of whole eye transplants with an aim to restore sight.

Eduardo D. Rodriguez, MD, DDS, the surgeon who led a team of more than 140 medical professionals who collaborated on the procedure, said: “We are truly amazed by Aaron’s recovery, with no episodes of rejection. Our methodical approach to the matching process, ensuring that Aaron received the most favorable donor match, along with our unique immunosuppression regimen, has set the standard for eliminating and avoiding early rejection episodes.”

The JAMA article details the 21-hour surgery that utilized innovative microsurgical techniques, customized surgical devices, and cell-based therapies. The procedure included the first attempt in injecting stem cells into a human optic nerve during transplant, aiming to enhance nerve regeneration.

The study also reports the results of clinical tests on the transplanted donor eye conducted over the past year. The examinations showed several hopeful results, such as normal eye pressure, good blood flow in the eye, and some remaining structure in the retina.

However, there has been no ability to see light, and noticeable damage to the optic nerve has resulted in some loss of retinal tissue. The authors noted that further evaluation is needed to draw more definitive conclusions.

Vaidehi S. Dedania, MD, James’ ophthalmologist and a retina specialist in the Department of Ophthalmology at NYU Langone, said: “The outcomes we’re seeing after this procedure are quite incredible and could pave the way for new clinical protocols and inspire further research into complex transplants involving critical sensory organs.”

A Year of Milestones

In the accident in 2021, James’ face came into contact with 7 thousand volts of electricity. He suffered serious damage to his left eye, nose, mouth, chin and teeth, as well as part of his left arm. Prior to the transplant, he was dependent on tubes to eat and to breathe.

James, now 46, said the past year has been marked by milestones most people take for granted: no more stares from strangers, the ability to enjoy solid foods again, and even the simple pleasures of smelling.

“I’m pretty much back to being a normal guy, doing normal things,” he said.

James continues regular follow-up appointments at NYU Langone and said he feels proud to be a part of such transformative research.

“I have felt honored to be patient zero. Even if I can’t see out of my new eye, I’ve gained my quality of life back, and I know this is a step forward in the path to help future patients,” he said.

Next Frontier: Vision Restoration

Whole eye transplants to restore vision have remained elusive due to the complex nature of the eye. The difficulties include maintaining retinal blood flow, preventing immune rejection, preserving how the eye responds to light, and ensuring the nerves and connections to the brain regrow and make functional connections to the brain.

“The first challenge is successfully transplanting an entire eye into a new human and keeping that eye alive without rejection—a feat Dr. Rodriguez and the NYU Langone team have achieved,” said Paul W. Glimcher, PhD, director of NYU Langone’s Neuroscience Institute and chair of the Department of Neuroscience and Physiology at NYU Grossman School of Medicine.

“It’s remarkable that some parts of the retina have survived over the past year. The critical task ahead is to ensure that all of the eye cells survive the transplant, which is essential for restoring connections to the brain. That is the fundamental requirement for vision, as sight is primarily a function of the brain, not just the eyes,” Glimcher said.