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Nikisha Richards, Edward Davidson, Eric Wang, Jenny Ying Yu, Juan Fernandez-Miranda, Kia M Washington; Surgical Considerations in Vascularized Composite Allotransplantation of the Eye. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4729.
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The concept of eye transplantation is not entirely novel. In 1885, Chibret unsuccessfully transplanted a rabbit eye into a blind girl and in 1977, the National Eye Institute called for a limited and thoughtful laboratory effort in eye transplantation. Methods for reconstruction or replacement of a non-functioning eye have to date traditionally been limited to prostheses with the limiting factors of whole eye transplantation including: failure by ganglion cell axon survival, insuring adequate circulation of blood to the transplanted eye and immune rejection of foreign tissue. We propose the surgical considerations in patient selection, implantation and surgical procedure in this prospective experimental model.
The critical technique prerequisite for successful transplantation surgery was the development of techniques for suturing blood vessels. Vascular anastomosis techniques have evolved tremendously most recently with vascularized composite allotransplantation (VCA). Anastomosis of donor and recipient ophthalmic arteries is well within the capabilities of a microsurgeon. Through cadaveric studies, we propose the anatomic considerations for the use of the angular or internal maxillary artery (IMAX) as ideal recipient vessels, a solution to the challenge of an anastomosis to the ophthalmic artery due to limited exposure and need to escape the zone of injury or pathology.
Given the larger caliber of the IMAX, it is preferred over the angular artery in some instances. We have successfully duplicated a surgical approach to the IMAX for recipient grafting: bicoronal incision followed by temporalis muscle turndown and extended lateral orbitotomy.
Given the highly specialized function of the eye and its unique anatomical components, VCA of the eye is an appealing novel method for restoration, replacement and reconstruction of the non-functioning eye. With the advent of image guidance and evolution of endoscopic techniques, this is certainly within the realm of practicality and this trial helps to bring eye transplantation closer to clinical reality.
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