Eye-in-a-Care-Box: device revives donor eyeballs for transplants

Pia Cosma and colleagues have built the Eye-in-a-Care-Box, a perfusion device that maintains and revives freshly removed eyeballs by delivering oxygen-rich fluid through the eye’s supplying artery and draining excess fluids, and that preserved retinal function in laboratory tests on pig and donated human eyes.

How does the Eye-in-a-Care-Box work?

The ECaBox pumps an oxygen-rich solution through the artery that normally supplies the eye, holds the globe on a "bed," drains away excess fluid, and seals the organ in a controlled chamber while a clear window permits imaging. The sealed chamber maintains a specific temperature and pressure while the perfusate restores some of the oxygen and nutrients the eye normally receives in the body.

Cosma’s team built the system over several years at the Centre for Genomic Regulation at the Barcelona Institute of Science and Technology and designed it so researchers can monitor and image an eye while it is being perfused.

What did the pig and human tests show?

Perfusion slowed degeneration and restored light responses: pig eyes kept outside the device degraded quickly, and cooling to 4°C (39°F) did not prevent degeneration within 24 hours, but eyes in the ECaBox were "significantly more viable" after 24 hours. In pig tests, light responses that were lost on removal returned after about 15 minutes of perfusion, and a few treated eyes continued to respond for 10 hours or more.

After the pig experiments, the team tested human tissue. They collected 12 eyes from six people who had died, placing one eye of each pair into the device and leaving the other untreated. The perfused eyes performed better in preservation tests and their retinas were maintained. The work is described in a preprint that has not yet been peer reviewed, and the authors did not want to comment beyond the paper.

Why does this matter?

If perfusion can preserve retinal structure and restore electrical responses after removal, it creates a new way to study human retinal biology and treatments ex vivo and could expand the options for donated-eye research without relying on living-animal experiments. Prior whole-eye transplant attempts have struggled to restore vision: in May 2023 a team at NYU Langone transplanted an eye with part of a face into a man who had lost his eye two years earlier, and although he recovered well, he was not able to see from the transplanted eye. As Shannon Tessier, who studies organ perfusion, put it, "It could be a new frontier for retina preservation." Still, whether ECaBox-treated eyes would yield better visual outcomes can only be answered after transplantation trials.

What to watch

Cosma and colleagues plan to build a portable, surgery-room version of the ECaBox to reduce degradation in heart-beating donor eyes when those donors become available. The clearest next signals will be additional human-eye work from the team, publication of peer review on the preprint, and any reports of transplanted eyes that were maintained with the device.