Aaron James, 47, is a citizen of Hot Springs, Arkansas, USA. He is an electrician by profession. In 2021, James suffered an electrical accident while performing maintenance on high-voltage lines. A strong current took away his dominant left arm, left eye, chin and nose. In later

Aaron James, 47, is a citizen of Hot Springs, Arkansas, USA. He is an electrician by profession. In 2021, James had an electrical accident while performing maintenance on high-voltage lines. The strong current took away his dominant left arm, left eye, chin and nose. In later years, he was unable to eat solid food, taste food, lose his sense of smell, or speak normally.

After undergoing surgery to transplant his left eye and part of his face, James returned home. His left eye now has photosensitivity. (Picture source: nyu langone health)

However, James is still lucky. Not only does he still have a wife and a daughter to take care of him, but after he was injured, he became the first patient in the world to undergo a full eye and face transplant. The person who performed the full eye and face transplant was NYU Langone Health in New York City, which was also the first medical institution in the world to perform genetically modified pig heart and pig kidney transplants to humans. The patient only survived After dozens of days, they all died, which means that transplantation of transgenic pig organs to humans has failed.

In May 2023, James received a full eye and face transplant at Langone Health Center. James is luckier than the patients who received pig heart and pig kidney transplants (because it is an allogeneic transplant). More than a year after the operation, he is still alive, and the transplanted eyes are still healthy, and the eyes can even respond to light, but James still The transplanted left eye cannot see the outside world that ordinary people can see.

So, is the full eye and face transplant that James received a success?

The world's first partial face transplant was performed by French doctors. On November 27, 2005, two French hospitals jointly completed the world's first partial face transplant. A woman who was bitten by a dog and disfigured became the first person in the world to undergo an allogeneic face transplant. Postoperatively, the patient survived for 11 years. In April 2011, Dallas Wiens, a 26-year-old man from Fort Worth, Texas, became the first person in the United States to receive a full face transplant. Wiens is still alive and well. From the perspective of postoperative survival time and quality of life, full face transplantation is successful. However, whether the full-eye transplant was successful is now controversial, because one year after James received the full-eye transplant, the transplanted eye still cannot see the world in front of him clearly.

Nonetheless, from another perspective, the world's first whole-eye transplant should be a success, because the patient is still alive, and although the transplanted eye cannot see objects, it has a photosensitive effect.

James' original eyes were blue. After losing his left eye, he had a brown eye transplanted, so the two eyes are now different colors, with the right eye blue and the left eye brown. From the perspective of surgical design and execution, total eye transplantation of the left eye was a successful attempt. The transplant team transplanted the donor's entire left eye, surrounding bone socket, nose, a piece of jaw bone, and related muscles, nerves and blood vessels to James. The operation lasted more than 20 hours.

This transplant surgery has several innovations. First, in order to ensure that the donor eye would not be ischemic for a long time, the surgical team modified the blood supply of the donor eye and connected the artery of the donor eye to a branch of the donor's external carotid artery, which is an artery that starts from the neck. Large blood vessels near the head. The entire eye assembly was then transplanted into James. This has never been done before.

Additionally, the surgical team created a pair of 3D-printed surgical guides that allowed doctors to harvest exactly the right amount of donor bone needed to fit James' face. The guides were based on computed tomography scans of the donor's and James' faces and were installed on their faces during surgery. Surgical guides guide doctors in the proper position for eye transplantation. Part of the success of

surgery is reflected in several aspects. One is that after the surgery, James could smell. Because after the accident, James also lost his nose and had no sense of smell for two years. The current surgery also involved a nose transplant, allowing him to smell after surgery. He joked that after being able to smell it, it smelled like a "hospital".

About a week and a half after the surgery, James saw his new face for the first time (with his existing right eye). Although he was also dumbfounded by the ferocious look on his face, he no longer wore an eyepatch and a mask when he went out like he did before his left eye was transplanted. Moreover, he was able to grow facial hair again. For this, James is very happy.

Although James' transplanted left eye can't see yet, his left eye has normal intraocular pressure and good blood flow. James can also feel itching deep in the orbit, and the sensation around the eye has begun to recover. And the transplanted retina in the left eye responded to light. This shows that the nerves around the eyes have regenerated randomly.

However, the biggest controversy is whether the retina of James's transplanted left eye will respond to light and whether the eye function will be restored, and whether the left eye will be able to see the outside world in the future. However, at the beginning of the operation, the surgical team assessed that the possibility of the transplanted left eye producing vision was too small.

Daniel Ceradini, a surgeon at Langone Health Center and one of the chief surgeons, believes there is no evidence that the optic nerve from the donor eye can be successfully reconnected to James' brain. How to regenerate the optic nerve, which is part of the central nervous system and carries information from the retina to the brain, is a mystery.

As for whether the transplanted left eye will regain vision in the future, it is more difficult to judge. Serardini thinks transplanted eyes may restore vision in the near future, but Bodin Pomahak, a surgeon at Yale University School of Medicine in New Haven, Conn., who was involved in the first full-face transplant in the United States in 2011, (Bohdan Pomahac, who was not involved in James' surgery) believes vision may not be restored.

However, they and other doctors agree that the key to allowing transplanted eyes to see the outside world lies in figuring out how the optic nerve regenerates. In the future, if we can figure out how the brain or spinal cord regenerates, it will be possible to figure out the principle of optic nerve regeneration and apply this principle to eye transplants, so that the transplanted eyeballs can also see the wonderful world outside.

James' wife Megan and their 19-year-old daughter Ellie also commented on James' eye transplant. Ellie believed that her father had created medical history.

Zhang Tiankan

Editor-in-Chief Zhu Liyuan