Neuro-Ophthalmologic Hurdles in Whole-Eye Transplantation

Anatomical and functional successes have extended into the field of vascularized composite allotransplantation. However, the goal of whole-eye transplantation continues as an unfinished effort, primarily because of difficulties accomplishing optic nerve repair and regeneration. This review provides a summary of neuro-ophthalmological findings regarding eye donors and recipients, based on ocular function in donors and neurophysiological events known to occur in blind people. Experimental advances regarding regeneration of the optic nerve in lower mammals have demonstrated anatomical success, but little is known regarding functional capacity. Modern imaging and functional studies in patients with brain death and patients with blindness have provided useful information concerning possible scenarios in whole-eye transplantation. Some questions remain regarding the functionality of an eye in a hypothetical donor, as well as the ability of the recipient’s visual pathway to perform adequately. A multidisciplinary approach, involving both clinical and basic research, is necessary to address the challenges of whole-eye transplantation.