Revolutionary Eye Preservation Device Could Make Whole-Eye Transplants a Reality

Whole-eye transplantation has long been one of medicine's greatest challenges: the procedure is extraordinarily complex, and an enucleated eye deteriorates rapidly once removed from the body. Although surgeons attempted a whole-eye transplant several years ago, the transplanted eye was ultimately unable to restore vision.

Now, researchers believe they may have found a solution — a device that uses perfusion technology to sustain and 'revive' a freshly removed eye, potentially making whole-eye transplantation a viable medical option.

What Is Perfusion Technology?

Perfusion works by continuously supplying a surgically removed organ with oxygen and nutrients, simulating the organ's normal in-body environment and thereby slowing deterioration. Eyes preserved using this technique not only degrade far more slowly but also retain the ability to transmit electrical signals and may even preserve potential visual function.

Shannon Tessier, a researcher at Massachusetts General Hospital who studies perfusion techniques for other organs but was not involved in this study, said: "This is really remarkable and could open up an entirely new field for retinal preservation."

How Does the ECaBox Work?

Pia Cosma and her team at the Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology, spent years developing the device, which they named the Eye-in-a-Care-Box, or ECaBox.

The device continuously delivers oxygenated fluid through the artery that normally supplies blood to the eye. The eyeball is placed on a custom support bed, and excess fluid is automatically drained. The unit is sealed to maintain a specific temperature and pressure, and transparent observation windows on the sides allow researchers to directly observe and photograph the eye without removing it from the device.

Pig Eye Experiment Results

Cosma's team first experimented with pig eyes, which are anatomically similar to human eyes and readily available — the team sourced theirs from a local abattoir.

The results were striking. Pig eyes left at room temperature deteriorated extremely rapidly, with cells shrivelling and ocular structures collapsing. Even when refrigerated at 4 °C (39 °F), eyes degraded completely within 24 hours.

By contrast, pig eyes preserved in the ECaBox performed significantly better. Tests at the 24-hour mark showed that perfused eyes had "substantially higher viability." Crucially, these eyes were still capable of responding to light — suggesting they could potentially support visual function if transplanted. Untreated pig eyes lost light-sensing ability immediately upon removal from the animal; however, this capacity was restored within approximately 15 minutes of perfusion. Some treated eyes maintained function for more than 10 hours.

Human Eye Experiments

Following the success of the pig eye trials, the team extended testing to human eyes. They collected 12 eyes from six deceased donors, placing one eye from each pair in the device and using the other as a control. Results were consistent: perfusion-preserved eyes performed better, and retinal condition was effectively maintained.

Cosma's team hopes the ECaBox will serve not only as a new research tool for studying ocular therapies — replacing the need for live animal experiments — but also, after further refinement, as a key technology for maintaining and reviving donated human eyes for whole-eye transplantation.

Current State and Challenges of Whole-Eye Transplantation

Whole-eye transplantation has previously been attempted on only a handful of occasions, primarily in research animals, with limited success. In May 2023, surgeons at NYU Langone transplanted an eye along with partial facial tissue to a man who had suffered severe damage to the left side of his face — including his left eye — in a high-voltage electrical accident two years earlier. Although the patient recovered well, the transplanted eye did not regain visual function.

Tessier noted that until an ECaBox-preserved eye is actually transplanted, it will be impossible to know whether the device can produce better outcomes.

The Cosma team is now planning to collect additional human eyes for research purposes using an upgraded version of the device. The researchers stated: "We plan to develop a portable, operating-room-ready version of the ECaBox so that deterioration can be minimised as soon as eyes from beating-heart donors become available."

The findings have been published as a preprint and have not yet undergone peer review.

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