No Longer in the Dark

Published in Wilmer - Fall 2021

April 9, 2015, was a sunny day in Kyiv, Ukraine. 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 when a de-pinned grenade fell short and rolled into a nearby trench. Popruzhenko dove for the grenade, but before he could throw it, the grenade exploded in his hands.

The force 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 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 highly specialized corneal transplant that was not available in Ukraine.

Over the next couple of years, Popruzhenko reminded himself — frequently — 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 depression.

Then, 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.” Troyanovskaya read about the U.S. Marine Corps Marathon, and with her encouragement, Popruzhenko began running. He qualified for a spot in the marathon reserved for wounded warriors. In July 2018, he and Troyanovskaya were married, and in October she accompanied him to Washington, D.C., for the marathon.

Answering a Call for Help

The couple stayed in the Maryland home of Ilona Doerfler. Born in Kyiv, she had come to the United States 29 years ago and had long participated in fundraising efforts and events to support the Ukrainian community. She was among those watching as Popruzhenko crossed the finish line. By the time the couple returned to Ukraine, Doerfler had begun formulating a plan to help him.

She reached out to Wilmer Eye Institute, where her daughter had been treated in 2000 to correct a condition known as lazy eye. Describing Popruzhenko’s plight, Doerfler asked Wilmer Director Peter J. McDonnell, M.D., whether the renowned institute could help Popruzhenko. The reply came quickly: He would need to be evaluated at Wilmer, but indeed there was hope.

With her letter, Doerfler set in motion a chain of events that would bring Popruzhenko to Wilmer for surgery that might allow him to see again. The complex operation would be performed by Wilmer corneal surgeon Esen Akpek, M.D., the Bendann Family Professor of Ophthalmology, and retinal surgeon Adam Wenick, M.D., Ph.D.

Through Collaboration, Hope

While Akpek had heard about Oleksandr’s injuries, it wasn’t until he came to Wilmer — nearly four years after the accident— 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 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.

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.

“One of the amazing things about working here at Wilmer and Johns Hopkins is that we are able to put together teams like this and do procedures that can only be done in a handful of places across the world,” says Wenick.

Four months after surgery, Popruzhenko had achieved 20/200 vision, which “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, O.T., to identify modifications and devices that would help maximize his vision. For example, he learned 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 — 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. For each person they help, it’s a miracle.”