Q&A: In the largest eye hospital in Ukraine, war-related injuries are part of the routine
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Eighteen months after the start of the war, about 20% of Ukrainian territory is occupied by Russia.
The port city of Odesa, “the pearl of the Black Sea,” has been repeatedly attacked by missiles and drones but strenuously defended from invasion by Ukrainian military forces.
Located in Odesa, the Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, one of the largest tertiary referral centers in the country, continues to provide highly specialized ophthalmological care and has a large ocular trauma department working incessantly to treat war injuries. To learn more about the current situation of ophthalmology at the institute and in Ukraine at large, Healio spoke with retina specialist Andrii Korol, MD, PhD, DMedSc, head of the institute’s laser division.
Healio: How has the war affected ophthalmology in the country?
Korol: We lost a lot of territory, a lot of people and a lot of ophthalmologists. Most of them moved away from occupied regions and bombed hospitals to other parts of the country, and several fled with their families to Moldova, Lithuania, Poland, Germany, Slovenia, Slovakia, Israel and the Czech Republic. They live there as refugees and cannot exercise their profession. Some of them come back to Ukraine for short periods to see patients and perform surgery, and then they rejoin their family abroad.
Here at the Filatov Institute, we have employed specialists, ophthalmologists and nurses who fled from occupied areas and cities that have been heavily under attack, such as Mariupol, Mykolaiv and Kherson, and some colleagues moved from Odesa to Kyiv, the capital city, or to Lviv, in the Western part of the country. So, there is a lot of instability and moving around of specialists. Here in Odesa, we live under the constant threat of shelling and drones, but our institute is working all the time at full capacity.
Healio: The Filatov Institute has a long history of dealing with ocular trauma. Please tell us more.
Korol: Our institution was established in 1936 and dealt with war-related ocular trauma during and after World War II, when the first and only specialized department for eye burns was established. Several types of keratoprostheses and keratoprosthesis methods were developed here. Hundreds of wounded soldiers and civilians were treated and regained vision.
Since the start of the conflict with Russia in 2014, we have been the referral center for wounded soldiers and civilians, and the volume of surgeries has increased tenfold in the past year and 5 months. We receive an average of 50 new wounded patients per week, including children. About 75 of the 450 inpatient beds are for ocular injuries, and we have a big outpatient department. Our trauma surgeons are highly specialized and highly skilled. Because we are the largest tertiary center for ocular trauma in our country, other hospitals often send us cases with an eye destined for enucleation and the other eye already blind. Our surgeons try everything, possible and impossible, to save the savable, and in many cases, they succeed in preserving at least light perception, if not several lines of vision.
We also have a specialized department that deals with soldiers who require treatment for brain concussion and secondary atrophy of the optic nerve, infections and uveitis. In my department, we have a lot of patients undergoing laser photocoagulation, photodynamic therapy or intravitreal injections for chronic serous chorioretinopathy, choroidal neovascularization, choroidal ruptures and other sequelae of war-related injuries. In addition, we have a big pediatric department, which takes care of injured children.
Healio: Do you have the staff resources to deal with this large hospital volume? Have you had any staffing shortage in the present situation?
Korol: Our director, professor Nataliya Pasyechnikova, does everything to keep our friendly medical team. About 99% of our staff is here. Only three ophthalmologists left. Overall, we have 700 people between medical and paramedical employees, and 200 are ophthalmologists.
Healio: What about ophthalmic equipment, surgical instruments, supplies and pharmaceuticals?
Korol: Ten years ago, substantial government funds were earmarked for the construction of a new five-floor building within our premises, with visiting rooms, laboratories and 12 operating rooms, fully equipped with the most advanced technology. The building became fully operational this year. We have the Navilas laser, the Alcon Ngenuity 3D system, Leica microscopes, the Alcon Centurion for cataract surgery and much more.
But we have a huge problem with medical supplies. There is a chronic shortage of critical supplies such as eye drops for anesthesia, mydriatic drops, as well as tissues for corneal transplantation, keratoprostheses and ocular prostheses. The European Society of Cataract and Refractive Surgeons is helping us, but it is not enough to cover our needs.
Even individual colleagues helped us in difficult times. Special thanks to professor Vilma Jurate Balciuniene from Lithuania, professor Anat Loewenstian from Israel, Dr. Sergiu Andronik, Dr. Valeriu Cusnir and Nicolae Bobescu from Moldova, Andrei Filip from Romania, Maciej Gawecki and Andrzej Grzybowski from Poland, Igor Kozak from the United Arab Emirates and Jeffrey K. Luttrull from the U.S. All these people and many others personally helped us.
Healio: Are you also short of anti-VEGF drugs for intravitreal injections?
Korol: Anti-VEGF drugs are not a problem because the companies helped us by lowering the price to the value of our currency. So, we are able to offer the registered drugs at an affordable price. We also have funding from the government to administer anti-VEGF injections free of charge for specific categories, such as those who are invalid and low-income citizens. Our intravitreal injection clinic is busy. And while COVID was a huge cause of disrupted injection schedules, war does not seem to be so.
Healio: How is everyday life in a hospital in the midst of a war?
Korol: We work all the time and even got used to the sound of air raid sirens. We did go underground when it started, but realistically, you cannot keep moving patients who are severely ill or injured from their beds. In the winter, we could rely on electricity and heating only a couple of hours per day, and we never knew when. We had generators for the operating rooms and other life-saving services, but our offices were freezing cold, and we had to wear gloves to operate the slit lamp or the OCT. We got by and even learned how to make coffee using the heat from a candle.
Ocular trauma surgeons work around the clock. Last year, we shared our operating room with the trauma department. There are three tables in this big OR — one was for ocular trauma and the other two for intravitreal injections. One day, we were performing our injections, and at the same time, a vitreoretinal surgeon started surgery for a severe trauma with foreign bodies, complete hyphema, huge iridodialysis, lens luxation and much more. After we had done our daily 40 injections and were about to leave the OR, the surgeon told us: “OK, we have just fixed the anterior chamber, so now we are in the vitreous.”
We also continue doing research, writing and publishing papers, and going through lengthy permission-seeking processes. I have been able to travel outside Ukraine to attend and present at congresses. This is vital for me, vital for us: keeping in touch, speaking and sharing experiences with my colleagues and friends.
For more information:
Andrii Korol, MD, PhD, DMedSc, can be reached at andrii.r.korol@gmail.com.
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