Systematic Review of Bilateral Ocular Trauma: Considerations for Future Whole-eye Transplantation.

Background: Bilateral ocular trauma (BLOT) is a rare but severe injury pattern associated with high-energy mechanisms and poor visual outcomes. As interest in vascularized composite allotransplantation grows, particularly following the first combined face transplantation (FT) and whole-eye transplantation (WET), a clearer understanding of BLOT injury patterns, interventions, and outcomes is needed to provide context for future discussions of bilateral WET. Methods: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using PubMed, Embase, CINAHL, Cochrane, and MEDLINE. Studies published through June 2024 were included if they reported patient-level data on BLOT mechanisms, injury type, outcomes, and surgical management. Results: A total of 268 patients with BLOT were identified, predominantly young men (72.4%) with a mean age of 29.9 years. Motor vehicle accidents (31.6%), explosions (21.4%), and fireworks (9.8%) were the leading mechanisms. Open-globe injuries (51.8%) were more frequent than closed-globe injuries, and the cornea (26.5%), limbus (15.5%), and lens (11.6%) were the most affected ocular regions. Globe-sacrificing procedures such as enucleation (2.1%) and evisceration (1.6%) were infrequent, and among studies reporting visual outcomes, bilateral blindness occurred in 38.7% of cases. Conclusions: Patients with BLOT were predominantly young men exposed to motor vehicle accidents and explosive trauma and, despite a high rate of bilateral blindness, often retained intact globes. Although vision restoration has not yet been achieved, these findings provide context for ongoing discussions of bilateral WET, whether performed in isolation or in combination with FT, within the evolving field of vascularized composite allotransplantation.