June 4, 2012
The Wilmer Eye Institute is excited to report that Nicholas Iliff, the Bendann/Iliff Professor of Ophthalmology and the Charles E. Iliff Professor of Surgical Ophthalmology at Johns Hopkins Hospital’s Bayview campus, was part of a team of over 150 physicians, nurses and professional staff that recently performed the world’s most extensive full face transplant at the University of Maryland Medical Center.
Iliff was approached for the project about a year ago by the lead surgeon, Eduardo D. Rodriguez, associate professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. Iliff has lectured on the ophthalmic concerns related to major facial reconstructive procedures at several conferences organized by Rodriguez, and the two have operated together in the past at Hopkins.
Iliff’s research has focused on abnormal eyelid blinking in ophthalmic trauma cases and the implications for reconstructive surgeons. After a trauma, nerves are often damaged and can grow back unevenly, causing the eyelids to function abnormally. In this case, the patient had good function in one eyelid but not the other. “While there was considerable challenge maintaining the blink on the normal side, the weakened blink on the other side was particularly tenuous and vulnerable,” said Iliff. He first evaluated the patient early last summer, discussed the ophthalmic issues with the transplant team, participated in the cadaver practice surgery and advised the team on what to do about the eyelid function.
This was the world’s first full face transplant that included the upper and lower jaw and nasal bones, and was performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery. It was also the first time an ophthalmic surgeon has been involved in a face transplant. Iliff participated in the surgery for about 6 of the 36 hours, performing and directing the eyelid portion of the procedure. The surgery occurred on March 19-20, 2012 at the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center.
So far the patient is doing well. The procedure was partly funded with a grant from the Department of Defense. Numerous wounded veterans from the wars in Iraq and Afghanistan may be candidates for such a surgery.
In the future, Iliff hopes to solve severe post-traumatic deformities of the eyelid with transplantation of the tissues surrounding the eyes. While face transplants involve a long process of pre-surgery testing, waiting for a suitable donor and a lifetime of anti-rejection medications, the procedure “has the great potential to dramatically improve the lives of many patients with devastating facial deformity,” said Iliff.