眼脸联合移植:显微手术策略和一年临床疗程

Daniel J Ceradini, David L Tran, Vaidehi S Dedania, Bruce E Gelb, Oriana D Cohen, Roberto L Flores, Jamie P Levine, Pierre B Saadeh, David A Staffenberg, Zakia Ben Youss, Patryk Filipiak, Steven H Baete, Eduardo D Rodriguez
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引用次数: 0

摘要

重要性:灾难性面部损伤并伴有眼球缺失仍是一个棘手的临床问题,此前没有关于通过全眼球或联合全眼球和面部移植进行重建的报道:设计、环境和参与者:一名46岁的男子因高压电伤导致面部和左眼球组织严重受损,在一家血管化复合异体移植专业中心接受了眼面部联合移植手术,手术中使用了个性化的手术设备和新颖的显微外科策略:主要结果和指标:全眼和面部异体移植的再灌注和存活率、视网膜功能和急性排斥反应的发生率:患者接受了免疫相容供体的全眼和面部联合移植手术,并进行了初级视神经接合和常规术后免疫抑制。荧光素血管造影显示,眼球和视网膜灌注在整个术后初期都得以维持。光学相干断层扫描显示视网膜内层萎缩,椭圆体区衰减和中断。连续视网膜电图证实了移植眼的视网膜对光线的反应。通过结构和功能磁共振成像,显示了移植眼视觉通路的完整性以及枕叶皮质对光刺激的潜在反应。移植后 1 年(术后第 366 天),移植眼没有光感:这是第一份关于全眼移植与面部移植相结合的报告,显示了异体移植存活率,包括无排斥移植存活率和视网膜电图测量显示视网膜对光刺激的反应。这些数据凸显了异体移植治疗眼球缺失的临床潜力。
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Combined Whole Eye and Face Transplant: Microsurgical Strategy and 1-Year Clinical Course.

Importance: Catastrophic 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.

Objective: To 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 participant: A 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 measures: Reperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.

Results: The 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 relevance: This 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.

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CiteScore
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期刊介绍: JAMA, published continuously since 1883, is an international peer-reviewed general medical journal. JAMA is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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