Restoring vision

After losing his vision in a hand grenade explosion, Oleksandr Popruzhenko underwent surgery at the Wilmer Eye Institute to restore his eyesight—and his quality of life

Video: Johns Hopkins Medicine

It was a sunny day in Kyiv, Ukraine when Oleksandr Popruzhenko, a 20-year-old senior lieutenant in the Ukrainian army, was training a group of 15 soldiers on the proper way to lob a grenade. Shortly into the training session, a de-pinned grenade fell short and rolled into a nearby trench. Without hesitating, Popruzhenko dove for the grenade, but before he could throw it, the grenade exploded in his hands.

The force of the explosion threw Popruzhenko backward. He couldn't see, and for a moment, he wondered if he was dead. But the pain convinced him he was still alive. Hundreds of grenade fragments had lodged under his skin and embedded in the muscles of his face, arms and legs—basically, anywhere that wasn't protected by his bulletproof vest and helmet.

At a military hospital in Odessa, doctors tended to his wounds. They were able to remove most of the foreign bodies from his eyes, repair the corneal perforations, and flatten the detached retina in his right eye, but they couldn't restore his vision. The left eye was beyond repair, they told him, and his only chance of regaining any vision in his right eye was to have a Boston keratoprosthesis corneal transplant, a highly specialized procedure that was not available in Ukraine.

Over the next couple of years, Popruzhenko reminded himself that he was lucky to be alive. But in Ukraine, there weren't many resources to support a young man who couldn't see, and it became increasingly difficult to stave off the depression that had begun to take hold.

Then, two years later in June 2017, Popruzhenko met Vlasta Troyanovskaya, and the two fell in love.

"Vlasta told me that I needed to do something," Popruzhenko says. "She said that I needed to move."

On the internet, Troyanovskaya read about the U.S. Marine Corps Marathon, an annual event with runners from more than 50 countries. With Troyanovskaya's encouragement, Popruzhenko began running, and he qualified for a spot in the marathon reserved for wounded warriors. In July 2018, he and Troyanovskaya were married, and in October of that year, she accompanied him to Washington, D.C., for the marathon.

Answering a call for help

Like Popruzhenko, Ilona Doerfler was born in Kyiv, but she came to the United States 29 years ago. As a member of the Ukrainian diaspora, Doerfler had, over the years, participated in fundraising efforts and events to support the Ukrainian community. So when a call came asking if she could provide lodging for a disabled Ukrainian veteran who was coming to town for the Marine Corp Marathon, she didn't hesitate.

Doerfler welcomed Popruzhenko and Troyanovskaya into her home in Maryland, and Popruzhenko shared the story of his accident. At the marathon, Doerfler was among those watching as Popruzhenko crossed the finish line.

Dr. Esen Akpek with Oleksandr Popruzhenko

Image caption: Dr. Esen Akpek with Oleksandr Popruzhenko

By the time Troyanovskaya and Popruzhenko returned to Ukraine, Doerfler had begun formulating a plan to help him. In 2000, her daughter had surgery at the Wilmer Eye Institute, to correct a condition known as lazy eye. Now Doerfler wrote to Wilmer director Peter McDonnell, describing Popruzhenko's plight. Wilmer had helped her daughter, Doerfler wrote. Could the renowned institute also help Popruzhenko? The reply came quickly: yes.

With her letter, Doerfler set in motion a chain of events that would bring Popruzhenko back to the U.S., to the Wilmer Eye Institute, for surgery that might allow him to see again. The complex operation would be performed by Wilmer corneal surgeon Esen Akpek and retinal surgeon Adam Wenick. Luba Stavitsky, an international care coordinator at Johns Hopkins Medicine, helped coordinate Popruzhenko's travel for his surgery and follow-up visits.

To raise money for travel, medicines and other costs, Doerfler organized a community bake sale and an Easter bazaar at the local Ukrainian Catholic church. She also appealed to United Help Ukraine, a nonprofit organization that allowed her to raise funds for Popruzhenko on its platform. Ultimately, more than 500 people around the world contributed over $32,000.

Through collaboration, hope

Meanwhile, at the Wilmer Eye Institute, doctors planned Popruzhenko's surgery. Akpek had heard about his injuries, but it wasn't until he came to Wilmer—nearly four years after the accident that claimed his vision—that she was able to gauge their extent. There was nothing Wilmer doctors could do for the left eye, but by performing artificial corneal transplant surgery and surgery to rehabilitate the retina at the same time, they hoped to restore some vision to his right eye.

Because the cornea—the clear front part of the eye—was damaged, the surgeons were unable to assess the state of the retina, which is behind it. Moreover, doctors in Ukraine had placed silicone oil in the eye, a practice often performed for severe retinal detachment. Now, that oil prevented the Wilmer team from viewing the back of the eye by ultrasound before surgery.

"20/200 is actually pretty good vision for a person who sustained such severe injuries. He was able to see the second big 'E' on the eye chart. He was able to walk around by himself. He was also able to see his wife's face for the first time."
Esen Akpek
Wilmer Eye Institute

In the operating room, Akpek first put a temporary artificial cornea on Popruzhenko to allow the team to view the eye's posterior structures—the optic nerve and the retina. Wenick then removed the oil and flattened the retina, and Akpek repaired the cornea. By the time it was over, the team had spent three and a half hours in the operating room.

Following such complex surgery, it can take several months to know if vision has improved. Four months after surgery, Popruzhenko had achieved 20/200 vision (20/20 vision refers to what people with normal vision can see from a distance of 20 feet). "20/200 is actually pretty good vision for a person who sustained such severe injuries," says Akpek. "He was able to see the second big 'E' on the eye chart. He was able to walk around by himself. He was also able to see his wife's face for the first time."

At Wilmer's Vision Rehabilitation department, Popruzhenko met with occupational therapist Kristen Shifflett to identify modifications and devices that would help maximize his vision. For example, Shifflett taught him that because he has very reduced contrast sensitivity, he needs light-colored objects against a black background and dark-colored objects against a light background. "If he's eating chicken, he should put it on a black plate for higher contrast," Shifflett says. "If he's having coffee, he can put it in a white mug so he can see the black coffee rise and he won't spill it."

To enlarge standard print for reading, Shifflett demonstrated how to use a desktop closed-circuit TV, which can also read content aloud—that is helpful for people experiencing visual fatigue. "He hadn't read in the longest time, so he was really hesitant at first," says Shifflett. "He was spelling out each letter initially, and then he was like, 'Oh, it's this word!' He was really excited."

Today, Popruzhenko can walk around unaided, although he uses a white cane to let others know he is visually impaired. He also runs regularly. "The incredible doctors at Wilmer, they have returned my sight," Popruzhenko says. "Thanks to them, I can see what time it is. I can see silhouettes of people, I can see colors. I am no longer in the dark."

For her part, Doerfler says, "I think all of us have an opportunity to make a difference in someone's life. It just was my turn, and it happened to be Oleksandr. I am very grateful for what the doctors at Wilmer did for him. I know it's their job and they do it every day, but for each person they help, it's a miracle."

This article originally appeared in the Wilmer Eye Institute newsletter, Wilmer in Focus.

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