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Total Human Eye Allotransplantation: Developing Surgical Protocols for Donor and Recipient Procedures

Davidson, Edward H. M.A.(Cantab.), M.B.B.S.; Wang, Eric W. M.D.; Yu, Jenny Y. M.D.; Fernandez-Miranda, Juan C. M.D.; Wang, Dawn J. M.D.; Richards, Nikisha M.D.; Miller, Maxine M.D.; Schuman, Joel S. M.D.; Washington, Kia M. M.D.

Plastic and Reconstructive Surgery: December 2016 - Volume 138 - Issue 6 - p 1297–1308
doi: 10.1097/PRS.0000000000002821
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Background: Vascularized composite allotransplantation of the eye is an appealing, novel method for reconstruction of the nonfunctioning eye. The authors’ group has established the first orthotopic model for eye transplantation in the rat. With advancements in immunomodulation strategies together with new therapies in neuroregeneration, parallel development of human surgical protocols is vital for ensuring momentum toward eye transplantation in actual patients.

Methods: Cadaveric donor tissue harvest (n = 8) was performed with orbital exenteration, combined open craniotomy, and endonasal approach to ligate the ophthalmic artery with a cuff of paraclival internal carotid artery, for transection of the optic nerve at the optic chiasm and transection of cranial nerves III to VI and the superior ophthalmic vein at the cavernous sinus. Candidate recipient vessels (superficial temporal/internal maxillary/facial artery and superficial temporal/facial vein) were exposed. Vein grafts were required for all anastomoses. Donor tissue was secured in recipient orbits followed by sequential venous and arterial anastomoses and nerve coaptation. Pedicle lengths and calibers were measured. All steps were timed, photographed, video recorded, and critically analyzed after each operative session.

Results: The technical feasibility of cadaveric donor procurement and transplantation to cadaveric recipient was established. Mean measurements included optic nerve length (39 mm) and caliber (5 mm), donor artery length (33 mm) and caliber (3 mm), and superior ophthalmic vein length (15 mm) and caliber (0.5 mm). Recipient superficial temporal, internal maxillary artery, and facial artery calibers were 0.8, 2, and 2 mm, respectively; and superior temporal and facial vein calibers were 0.8 and 2.5 mm, respectively.

Conclusion: This surgical protocol serves as a benchmark for optimization of technique, large-animal model development, and ultimately potentiating the possibility of vision restoration transplantation surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Pittsburgh, Pa.

From the Departments of Plastic Surgery, Otolaryngology, Ophthalmology, and Neurosurgery, University of Pittsburgh School of Medicine; and the VA Pittsburgh Healthcare System.

Received for publication August 31, 2015; accepted July 29, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch. On the iPad, tap on the Hot Topics icon.

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Kia M. Washington, M.D., Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, Scaife Hall, Suite 668, Pittsburgh, Pa. 15261, washingtonkm@upmc.edu

©2016American Society of Plastic Surgeons