Ukrainian surgeons face multiple challenges treating severe combat ocular trauma
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MILAN — Caring for patients in conflict zones, Ukrainian ophthalmologists work under constant pressure and face multiple challenges.
“Many of our clinics have been destroyed or occupied, doctors and nurses have been evacuated, and the logistics for the delivery of consumables have been disrupted,” Andrii Ruban, MD, PhD, president of the Ukrainian Vitreoretinal Society, said at the European Society of Cataract and Refractive Surgeons meeting.
Ruban, who runs the Center of Clinical Ophthalmology in Kyiv, has had to deal over the past 7 months of war with severe combat eye injuries, “the hardest thing I have ever encountered, with horrific anatomic disruption,” he told the audience. In 92% of cases, they were blast injuries, leading to a high level of complex ocular polytrauma associated with adnexal and orbital trauma in 63% of cases, often associated with other head, neck, face or systemic injuries. Perforating injuries were present in 71% of the eyes, with intraocular foreign bodies in 44%.
“Often, the size of such traumas does not leave a chance for vision,” Ruban said. “In our series, one in five patients had bilateral lesions, one in three was blind in one eye and almost one in 10 in both eyes.”
Operations are frequently performed in operating rooms that are not adapted for ophthalmic procedures, and surgery has overall changed dramatically.
“Forget about our minimally invasive vitrectomies of peacetime. We have mostly gone back to 20-gauge surgery, operating on both eyes at the same time, using a combination of different techniques, and we need the skills of an anterior, posterior and oculoplasty surgeon. The complexity of the cases has a high risk for reoperations, complications and [proliferative vitreoretinopathy],” he said.
Another challenge is the severe emotional trauma these patients have suffered, the burden of which falls on relatives and doctors. Medical staff in military hospitals are also experiencing psychological overload, constantly living in the clinic and working around the clock without contact with their families.
“But the main thing is to defend our country, our right to life and our future,” Ruban said.
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Ruban A. Challenges in treating patients during the Ukraine-Russian war. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 16-20, 2022; Milan.
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