ImportanceCatastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.ObjectiveTo develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.Design, Setting, and ParticipantA 46-year-old man who sustained a high-voltage electrical injury with catastrophic tissue loss to his face and left globe underwent combined whole eye and face transplant using personalized surgical devices and a novel microsurgical strategy at a specialized center for vascularized composite allotransplantation.Main Outcomes and MeasuresReperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.ResultsThe patient underwent a combined whole eye and face transplant from an immunologically compatible donor with primary optic nerve coaptation and conventional postoperative immunosuppression. Globe and retinal perfusion were maintained throughout the immediate postoperative period, evidenced by fluorescein angiography. Optical coherence tomography demonstrated atrophy of inner retinal layers and attenuation and disruption of the ellipsoid zone. Serial electroretinography confirmed retinal responses to light in the transplanted eye. Using structural and functional magnetic resonance imaging, the integrity of the transplanted visual pathways and potential occipital cortical response to light stimulation of the transplanted eye was demonstrated. At 1 year post transplant (postoperative day 366), there was no perception of light in the transplanted eye.Conclusions and RelevanceThis is the first report of whole eye transplant combined with facial transplant, demonstrating allograft survival including rejection-free graft survival and electroretinographic measurements indicating retinal response to light stimuli. These data highlight the potential for clinical allotransplantation for globe loss.

中文翻译：

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全眼和面部联合移植


重要性伴有眼球丧失的灾难性面部损伤仍然是一个令人生畏的临床问题，以前没有关于全眼或全眼和面部联合移植重建的报道。目的制定全眼和面部联合移植的显微外科策略，并描述移植后 1 年的临床表现。设计、设置和参与者一名 46 岁的男性遭受高压电击，面部和左眼球组织严重流失，在血管化复合同种异体移植的专业中心接受了使用个性化手术设备和新型显微外科策略的全眼和面部联合移植。主要结局和措施全眼和面部同种异体移植物的再灌注和活力、视网膜功能和急性排斥反应的发生率。结果患者接受了免疫相容性供体的全眼和面部联合移植，该供体具有原发性视神经接合和常规术后免疫抑制。眼球和视网膜灌注在整个术后即刻保持，荧光素血管造影证明。光学相干断层扫描显示视网膜内层萎缩以及椭球区的衰减和破坏。连续视网膜电图证实了移植眼中视网膜对光的反应。使用结构和功能磁共振成像，证明了移植视觉通路的完整性和枕叶皮层对移植眼光刺激的潜在反应。移植后 1 年 （术后第 366 天），移植的眼睛没有光感。结论和相关性这是全眼移植联合面部移植的首次报道，证明了同种异体移植物存活率，包括无排斥反应移植物存活率和表明视网膜对光刺激反应的视网膜电图测量。这些数据强调了临床同种异体移植治疗眼球丢失的潜力。