A Visionary Team Effort: Total Eye Transplants
Surgery is “quite close,” but regenerative and immune response barriers remain
Researchers at Bascom Palmer Eye Institute and around the world have been developing new techniques to perform total eye transplants — an interdisciplinary moonshot project. At the Miller School alone, 16 faculty members (see full list below) are committed to making this happen, including experts in neurosurgery, biomedical engineering, transplant surgery, plastic surgery, immunology and ophthalmology.
“In some respects, we are quite close to the final product,” said Daniel Pelaez, Ph.D. ’11, research associate professor of ophthalmology and scientific director of the Dr. Nasser Al-Rashid Vision Research Center. “Bascom Palmer has been leading the way on the surgical techniques to harvest, transplant and rehabilitate the eye.”
Dr. Pelaez is co-principal investigator on the project with David Tse, M.D., professor of ophthalmology and holder of the Dr. Nasser Ibrahim Al-Rashid Chair in Ophthalmology.
There’s still much work to do, but eventually this procedure will be a big win for many patients, including people who have lost an eye to cancer or trauma and those with advanced macular degeneration or glaucoma.
The immune response to eye transplantation is a significant unknown. While the eye’s inside is considered immune privileged (immune cells don’t generally go there), the outside is not. Ocular immunologists are working to understand how the immune system responds to a transplanted eye.
Perhaps the most significant barrier is connecting the optic nerve. Like the spinal cord, the nerve is part of the central nervous system; connecting it to the nervous system is incredibly challenging. This will go beyond surgery, as researchers must develop new methods to regenerate and heal the reconnected nerve.
“We’ve been learning from our research on how to treat trauma to the optic nerve where we can promote regeneration,” Dr. Pelaez said. “We need to build on that research to develop more robust methods. We’ve also learned that the molecular mechanisms that drive internal heat generation in warm-blooded animals interfere with the regenerative processes in the central nervous system. In the last couple of studies, we’ve modulated those mechanisms and have improved the process, which can translate to spinal cord or any central nervous system regeneration.”
A Visionary Team Effort
A Team of Experts
Bascom Palmer’s physicians and scientists on the total eye transplant team include Felipe Medeiros, M.D., Ph.D., professor of ophthalmology and vice chair of research. He will provide expertise in data science and bioinformatics. Also on the team is Jean-Marie Parel, ETS-G, Ph.D., the director of the ophthalmic biophysics center, who has created more than 350 surgical instruments and clinical devices that have enhanced clinical optic care worldwide. Jianhua (Jay) Wang, M.D., Ph.D., an electrical and computer engineer, has developed a wide range of imaging modalities that study structural and functional alterations in the eyes. Additionally, Victor Perez, M.D., an expert in ocular immunology will evaluate the immune response to eye transplantation and devise immunomodulatory strategies for the success of the procedure. Vittorio Porciatti, D.Sc., Bascom Palmer’s director of research, will bring his expertise as a neuroscientist, retinal electrophysiologist and biomedical engineer.
University of Miami collaborators on the project include Carolina Benjamin, M.D., a neurosurgeon expert in microsurgical anatomical dissections within the skull base who worked with Dr. Tse on the refinement of the novel surgical approach to eye transplantation; Ashutosh Agarwal, Ph.D., a biomedical engineer working in collaboration with Drs. Parel and Porciatti on an eye organ life-support system (eye-ECMO™) to maintain the donor eye alive and functional; and Robert Levy, Ph.D., a microbiology and immunology professor working alongside Dr. Perez on the immunological aspects of the project.
Clifton McClenney and Louay Hatem, M.D., the senior director of operations and medical director of the Life Alliance Organ Recovery program, respectively, will coordinate with other organ transplantation teams and facilities to develop harmonized guidelines for the successful recovery of human donor eyes. Alfred Tector, M.D., and Rodrigo Vianna, M.D., Ph.D., from the Miami Transplant Institute, are specialists in the technical modifications necessary for organ transplantations. Finally, plastic surgeons Kyle Y. Xu, M.D., and Devinder Singh, M.D., are experts in microsurgery, specifically microvascular reconstruction.
Daniel Pelaez, Ph.D.
University of Miami Medicine
FALL 2024
