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Total Human Eye Allotransplantation (THEA): Developing surgical protocols for donor and recipient procedures
Edward H. Davidson MA (Cantab.) MBBS, Eric W. Wang MD, Jenny Y. Yu MD, Juan C. Fernandez-Miranda MD, Dawn J. Wang MD, Maxine R. Miller, MD, MS, Yang Li MD Ph.D, Mario G. Solari MD, Joel S. Schuman MD, Vijay S. Gorantla MD, Ki
University of Pittsburgh Department of Plastic Surgery
2015-03-14
Presenter: Edward H Davidson
Affidavit:
The conceptualization, design, data collection and analysis in this study is the work of the resident first author. All other authors were involved in a collaborative/mentoring role and/or providing technical assistance
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
Vascularized composite allotransplantation is an appealing novel method for restoration, replacement and reconstruction of the non-functioning eye. With advancements in immunomodulation strategies together with new therapies in neuroregeneration, development of human surgical protocols is vital in ensuring momentum towards eye transplantation in actual patients.
Methods
Cadaveric tissue harvest was performed with orbital exenteration and endonasal approach to ligate the ophthalmic artery at the suprasellar cistern, for transection of the optic nerve at the optic chiasm and for transection of occulomotor, trochlear and abducens nerves at the cavernous sinus. Superior and inferior ophthalmic veins were harvested at the cavernous sinus. For cadaveric recipient procedures, internal maxillary artery and contralateral superior ophthalmic vein were exposed. Donor tissue was secured in recipient orbits followed by sequential venous and arterial anastomosis and nerve coaptation. Measurements of pedicle lengths and caliber were recorded. Steps were timed, photographed, and critically analyzed.
Results
Measurements included: optic nerve pedicle 39mm, ophthalmic artery 13.5mm, ophthalmic artery caliber 1mm, superior ophthalmic vein 15mm, superior ophthalmic vein caliber 0.5mm. Recipient anastomoses to internal maxillary artery (1.5mm caliber) and superior ophthalmic vein (0.5mm caliber) were achieved with standard microsurgical techniques but required vein grafting unless a stem of internal carotid artery was harvested. Nerve coaptation was achieved with fibrin adhesive and nerve wraps.
Conclusions
This protocol serves as a benchmark for potentiating the scope of face transplants to include eye tissue as well as revolutionizing the clinical management of visual impairment by introducing the possibility of vision restoration transplantation surgery.
