My Impression of the War

Prof Ihor Novytskyy Lviv National Medical University, Ukraine

When the Russian Federation’s war against Ukraine began, I had an extreme desire to defend my homeland with weapons in both hands. But my friends convinced me that I could be much more useful in the operating room. Unfortunately, their assumption became real.

Every case of combat eye injury leaves an unhealed impression.

I would like to share a few cases that I will never forget:

The first case was a boy under 22, a very young guy, a civilian. He had been brushing his teeth and looked out the window at the very moment a bomb exploded. The shrapnel has wounded his face, head, and both his eyes. Corneal and scleral wounds were sutured at the battlefront.

When he was brought to our clinic in Lviv, one eye was completely destroyed, and the other had a subconjunctival rupture of the sclera, complete vitreous haemorrhage, and total retinal detachment. Visual acuity of this eye was an incorrect light perception.

The operation lasted more than five hours. At first, it was impossible to distinguish between the blood, the membranes, and the retina. The operation ended with a 360-degree circumferential and radial retinotomy, and an endotamponade with silicone oil. The retina was grey, and I had no hope for him to recover the slightest sight ability. After ten days of recovery, the BCVA was 0.01, and I am happy I could give him back at least some sight.

The second case was a young man, a soldier. Blast injury of both eyes. Torn corneal wounds, iris tears, traumatic cataracts, vitreous haemorrhages. When I saw those eyes, I realised there was no other way out—I had to operate on them! But would I manage? I’ve done everything possible: rearrange the sutures to the cornea, sutured the iris, performed cataract extraction and pars plana vitrectomy, implanted an IOL, and sutured it to the sclera. Result: BCVA of the better eye is 0.02; the other has light perception.

The third case was a patient with a traumatic macular hole. But when brought to me, something else struck me—the boy had both his legs amputated. I hoped to restore his sight, but no one could return his legs!

The fourth case: Military, not young anymore, a strong man. The guy was silent, but I could feel his despair and hopelessness. He had had surgery before coming to Lviv.

His crushing despondency painfully hit me as my own. He was wounded and covered with dirt. One eye was destroyed—very badly injured and with endophthalmitis. The second eye had sutured corneal wound, swollen cornea, hyphaema, iris coloboma, aphakia, and silicone oil tamponade. The fundus could not be ophthalmoscopically examined. Ultrasound examination was unclear. Incorrect light perception. I understood something was wrong inside, and I waited for the cornea to become more transparent before an operation. I removed the epithelium and the silicone oil. There was almost no retina on the temporal side, silicone under the retina. The retina was shortened and shrunken. I straightened it in the best way I could, but there was no central part of the retina. I felt powerless…

Now I am gathering energy for the treatment of other wounded who are defending Ukraine and, therefore, me.