Oculocardiac Reflex During Intravitreal Injection
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 9 No. 2 (2020),
4 March 2020
,
Page 111-117
Abstract
Oculocardiac reflex (OCR) has been described to occur with mechanical manipulation of the eye, eyelids or orbit. There are no reports in the literature of OCR during intravitreal injection (IVI). This may be due to the fact that heart rate is not monitored during the procedure. We aimed to evaluate OCR during IVI. A total of 532 patients were enrolled in the study in Asociacion para Evitar la Ceguera en Mexico. Mexico City, Mexico. IVI was performed on one eye in every patient with diabetic retinopathy (DR), age related macular degeneration (AMD) or choroidal neovascularization (CNV) secondary to pathological myopia. Heart rate was monitored with a pulse oximeter before, during and after injection. OCR was defined as a 20% decrease or more of basal heart rate. The population enrolled included 270 females and 262 males with mean age of 63.8 years. A decrease in heart rate of 20% or more occurred in 18 patients during IVI (3.3%; 95% confidence interval 1.85% and 4.92%). OCR was asymptomatic in these patients. OCR occurred in 3.3% of our patients during IVI. Hence, OCR must be considered when performing IVI.References
Mirakhur RK, Jones CJ. Oculocardiac Reflex. British Journal of Anaesthesia. 1983;55(9). doi: 10.1093/bja/55.9.921
Bharati SJ, Chowdhury T. The Oculocardiac Reflex. Trigeminocardiac Reflex2015. p. 89-99.
Arnold RW. The human heart rate response profiles to five vagal maneuvers. Yale J Biol Med. 1999;72(4):237-44. pmid: 10907774
Cheung MY, Viney M. A unique case of recurrent asystole secondary to paroxysmal pain of acute herpetic ophthalmicus. Anesth Analg. 2007;105(4):1127-9, table of contents. doi: 10.1213/01.ane.0000280536.96489.95 pmid: 17898398
Gold RS, Pollard Z, Buchwald IP. Asystole due to the oculocardiac reflex during strabismus surgery: a report of two cases. Ann Ophthalmol. 1988;20(12):473-5, 7. pmid: 3064667
Osborn TM, Ueeck BA, Ham LB, Assael LA. A case of asystole from periorbital laceration manipulation and oculocardiac reflex in an acute trauma setting. J Trauma. 2008;65(1):228-30. doi: 10.1097/01.ta.0000195450.92536.7f pmid: 17429330
A Van Noord B. Asystole during Vitrectomy Secondary to Increasing Intraocular Infusion Pressure Transmitted via Sclerotomy Infusion Cannula. Journal of Anesthesia & Clinical Research. 2012;03(03). doi: 10.4172/2155-6148.1000198
Min SW, Hwang JM. Adjustment in patients with asystole during strabismus surgery. Graefes Arch Clin Exp Ophthalmol. 2011;249(12):1889-92. doi: 10.1007/s00417-011-1628-6 pmid: 21301860
Milot JA, Jacob JL, Blanc VF, Hardy JF. The oculocardiac reflex in strabismus surgery. Can J Ophthalmol. 1983. doi:10.1201/b16817-84.
Karaman T, Demir S, Dogru S, Sahin A, Tapar H, Karaman S, et al. The effect of anesthesia depth on the oculocardiac reflex in strabismus surgery. J Clin Monit Comput. 2016;30(6):889-93. doi: 10.1007/s10877-015-9789-1 pmid: 26438656
Tuzcu K, Coskun M, Tuzcu EA, Karcioglu M, Davarci I, Hakimoglu S, et al. Effectiveness of sub-Tenon's block in pediatric strabismus surgery. Braz J Anesthesiol. 2015;65(5):349-52. doi: 10.1016/j.bjane.2014.02.003 pmid: 26323732
Baykara M, Dogru M, Ozmen AT, Ozcetin H. Oculocardiac reflex in a nonsedated laser in situ keratomileusis patient. J Cataract Refract Surg. 2002;28(9):1698-9. doi: 10.1016/s0886-3350(01)01113-0 pmid: 12231334
Paciuc M, Mendieta G, Naranjo R. Oculocardiac reflex during laser in situ keratomileusis. J Cataract Refract Surg. 1998;24(10):1317-9. doi: 10.1016/s0886-3350(98)80221-6 pmid: 9795844
Cui W. [Blepharoplasty and oculocardiac reflex]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1993;9(5):355-6, 97. pmid: 8143207
Matarasso A. The oculocardiac reflex in blepharoplasty surgery. Plast Reconstr Surg. 1989;83(2):243-50. doi: 10.1097/00006534-198902000-00006 pmid: 2911623
Katowitz WR, O'Brien M, Kiskis E, Elliott EM. An asystolic event after eyelid skin bupivicaine injection during chalazion surgery. J AAPOS. 2016;20(1):75-7. doi: 10.1016/j.jaapos.2015.09.010 pmid: 26917079
Hampl KF, Marsch SC, Schneider M, Flammer J. Vasovagal heart block following cataract surgery under local anesthesia. Ophthalmic Surg. 1993;24(6):422-4. pmid: 8336897
Gao L, Tao Z, Wang Q. [Oculocardiac reflex in senile cataract operation]. Zhonghua Yan Ke Za Zhi. 1997;33(5):334-6. pmid: 10451974
Gao L, Wang Q, Xu H, Tao Z, Wu F. The oculocardiac reflex in cataract surgery in the elderly. Br J Ophthalmol. 1997;81(7):614. doi: 10.1136/bjo.81.7.614 pmid: 9290386
Kosaka M, Asamura S, Kamiishi H. Oculocardiac reflex induced by zygomatic fracture; a case report. J Craniomaxillofac Surg. 2000;28(2):106-9. doi: 10.1054/jcms.2000.0107 pmid: 10958423
Woernley TC, Wright TL, Lam DN, Jundt JS. Oculocardiac Reflex in an Orbital Fracture Without Entrapment. J Oral Maxillofac Surg. 2017;75(8):1716-21. doi: 10.1016/j.joms.2017.03.014 pmid: 28412263
Joseph JM, Rosenberg C, Zoumalan CI, Zoumalan RA, White WM, Lisman RD. Oculocardiac reflex associated with a large orbital floor fracture. Ophthalmic Plast Reconstr Surg. 2009;25(6):496-8. doi: 10.1097/IOP.0b013e3181b80ea7 pmid: 19935262
Young TE. Pharmacology Review: Topical Mydriatics: The Adverse Effects of Screening Examinations for Retinopathy of Prematurity. NeoReviews. 2003;4(6):163e-6. doi: 10.1542/neo.4-6-e163
Mimura T, Amano S, Funatsu H, Araie M, Kagaya F, Kaji Y, et al. Oculocardiac reflex caused by contact lenses. Ophthalmic Physiol Opt. 2003;23(3):263-4. doi: 10.1046/j.1475-1313.2003.00114.x pmid: 12753482
Ha SG, Huh J, Lee BR, Kim SH. Surgical factors affecting oculocardiac reflex during strabismus surgery. BMC Ophthalmol. 2018;18(1):103. doi: 10.1186/s12886-018-0771-9 pmid: 29673326
Defalque RJ. Retrobulbar block for oculocardiac reflex: duration of protection by common local anesthetics. Acta Ophthalmol (Copenh). 1969;47(4):998-1003. doi: 10.1111/j.1755-3768.1969.tb03723.x pmid: 5394852
Gilani SM, Jamil M, Akbar F, Jehangir R. Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery. J Ayub Med Coll Abbottabad. 2005;17(4):57-9. pmid: 16599038
Meyers EF, Tomeldan SA. Glycopyrrolate compared with atropine in prevention of the oculocardiac reflex during eye-muscle surgery. Anesthesiology. 1979;51(4):350-2. doi: 10.1097/00000542-197910000-00017 pmid: 484900
Hunsley JE, Bush GH, Jones CJ. A study of glycopyrrolate and atropine in the suppression of the oculocardiac reflex during strabismus surgery in children. Br J Anaesth. 1982;54(4):459-64. doi: 10.1093/bja/54.4.459 pmid: 7066144
Safavi M, Honarmand A. Comparison of effects of thiopental, propofol or ketamine on the cardiovascular responses of the oculocardiac reflex during strabismus surgery. J Res Med Sci. 2007.
Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol. 2019;19(1):36. doi: 10.1186/s12871-019-0712-z pmid: 30871507
Paciuc M, Mendieta G, Naranjo R, Angel E, Reyes E. Oculocardiac reflex in sedated patients having laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 1999;25(10):1341-3. doi: 10.1016/s0886-3350(99)00209-6
Arnold RW, Jensen PA, Kovtoun TA, Maurer SA, Schultz JA. The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q. 2004;19(4):215-22. pmid: 15530138
Arnold RW, Biggs R, Beerle B. Dexmetadomidine (Precedex) increases oculocardiac reflex. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2017;21(4). doi: 10.1016/j.jaapos.2017.07.133
Arnold RW, Biggs RE, Beerle BJ. Intravenous dexmedetomidine augments the oculocardiac reflex. J AAPOS. 2018;22(3):211-3 e1. doi: 10.1016/j.jaapos.2018.01.016 pmid: 29733898
Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, et al. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol. 2015;2015:627674. doi: 10.1155/2015/627674 pmid: 26417453
Ferrara N, Damico L, Shams N, Lowman H, Kim R. Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina. 2006;26(8):859-70. doi: 10.1097/01.iae.0000242842.14624.e7 pmid: 17031284
Amadio M, Govoni S, Pascale A. Targeting VEGF in eye neovascularization: What's new?: A comprehensive review on current therapies and oligonucleotide-based interventions under development. Pharmacol Res. 2016;103:253-69. doi: 10.1016/j.phrs.2015.11.027 pmid: 26678602
Osaadon P, Fagan XJ, Lifshitz T, Levy J. A review of anti-VEGF agents for proliferative diabetic retinopathy. Eye (Lond). 2014;28(5):510-20. doi: 10.1038/eye.2014.13 pmid: 24525867
Das A, McGuire PG, Rangasamy S. Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology. 2015;122(7):1375-94. doi: 10.1016/j.ophtha.2015.03.024 pmid: 25935789
Scaramuzzi M, Querques G, Spina CL, Lattanzio R, Bandello F. Repeated intravitreal dexamethasone implant (Ozurdex) for diabetic macular edema. Retina. 2015;35(6):1216-22. doi: 10.1097/IAE.0000000000000443 pmid: 25574787
Khan Z, Kuriakose RK, Khan M, Chin EK, Almeida DR. Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications. Ophthalmic Surg Lasers Imaging Retina. 2017;48(2):160-6. doi: 10.3928/23258160-20170130-10 pmid: 28195619
Matonti F, Pommier S, Meyer F, Hajjar C, Merite PY, Parrat E, et al. Long-term efficacy and safety of intravitreal dexamethasone implant for the treatment of diabetic macular edema. Eur J Ophthalmol. 2016;26(5):454-9. doi: 10.5301/ejo.5000787 pmid: 27079207
Gonzalez-Salinas R, Hernandez-Zimbron LF, Gulias-Canizo R, Sanchez-Vela MA, Ochoa-De La Paz L, Zamora R, et al. Current Anti-Integrin Therapy for Ocular Disease. Semin Ophthalmol.2018;33(5):634-42. doi: 10.1080/08820538.2017.1388411 pmid: 29087767
Grzybowski A, Told R, Sacu S, Bandello F, Moisseiev E, Loewenstein A, et al. 2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations. Ophthalmologica. 2018;239(4):181-93. doi: 10.1159/000486145 pmid: 29393226
Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TYY, Larsen M, et al. Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management. Ophthalmology. 2017;124(11):1690-711. doi: 10.1016/j.ophtha.2017.04.028 pmid: 28655539
Gupta N, Mansoor S, Sharma A, Sapkal A, Sheth J, Falatoonzadeh P, et al. Diabetic retinopathy and VEGF. Open Ophthalmol J. 2013;7:4-10. doi: 10.2174/1874364101307010004 pmid: 23459241
Das A, Stroud S, Mehta A, Rangasamy S. New treatments for diabetic retinopathy. Diabetes Obes Metab. 2015;17(3):219-30. doi: 10.1111/dom.12384 pmid: 25160598
Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2014(8):CD005139. doi: 10.1002/14651858.CD005139.pub3 pmid: 25170575
Kovach JL, Schwartz SG, Flynn HW, Jr., Scott IU. Anti-VEGF Treatment Strategies for Wet AMD. J Ophthalmol. 2012;2012:786870. doi: 10.1155/2012/786870 pmid: 22523653
Browning DJ, Kaiser PK, Rosenfeld PJ, Stewart MW. Aflibercept for age-related macular degeneration: a game-changer or quiet addition? Am J Ophthalmol. 2012;154(2):222-6. doi: 10.1016/j.ajo.2012.04.020 pmid: 22813448
Dessau R, Pipper C. [''R"--project for statistical computing]. Ugeskr Laeger. 2008.
Eloyan A, Li S, Muschelli J, Pekar JJ, Mostofsky SH, Caffo BS. Analytic programming with FMRI data: a quick-start guide for statisticians using R. PLoS One. 2014;9(2):e89470. doi: 10.1371/journal.pone.0089470 pmid: 24586801
Jalal H, Pechlivanoglou P, Krijkamp E, Alarid-Escudero F, Enns E, Hunink MGM. An Overview of R in Health Decision Sciences. Med Decis Making. 2017;37(7):735-46. doi: 10.1177/0272989X16686559 pmid: 28061043
Machida CJ, Arnold RW. The effect of induced muscle tension and fatigue on the oculocardiac reflex. Binocul Vis Strabismus Q. 2003;18(2):81-6. pmid: 12785319
Arnold RW, Ellis FD, Wolfe TM. Prolonged oculocardiac reflex during strabismus surgery under topical anesthesia. J Pediatr Ophthalmol Strabismus. 1997;34(4):252-4. pmid: 9253742
Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand. 2008;52(9):1273-7. doi: 10.1111/j.1399-6576.2008.01745.x pmid: 18823468
Ghali AM, El Btarny AM. The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery. Anaesthesia. 2010;65(3):249-53. doi: 10.1111/j.1365-2044.2009.06191.x pmid: 20039868
Jackson BF. Orbital trauma, bradycardia, and vomiting: trapdoor fracture and the oculocardiac reflex: a case report. Pediatr Emerg Care. 2010;26(2):143-5. doi: 10.1097/PEC.0b013e3181ce30d8 pmid: 20145507
Chung SY, Langer PD. Pediatric orbital blowout fractures. Curr Opin Ophthalmol. 2017;28(5):470-6. doi: 10.1097/ICU.0000000000000407 pmid: 28797015
Jurdy L, Malhotra R. White-eyed medial wall blowout fracture mimicking head injury due to persistent oculocardiac reflex. J Craniofac Surg. 2011;22(5):1977-9. doi: 10.1097/SCS.0b013e31822eaa25 pmid: 21959489
Basagaoglu B, Steinberg A, Tung IT, Olorunnipa S, Maricevich RS. Oculocardiac Reflex as a Late Presentation of Orbital Floor Fracture. J Craniofac Surg. 2018;29(7):e720-e2. doi: 10.1097/SCS.0000000000004966 pmid: 30192295
Fauser S, Schwabecker V, Muether PS. Suppression of intraocular vascular endothelial growth factor during aflibercept treatment of age-related macular degeneration. Am J Ophthalmol. 2014;158(3):532-6. doi: 10.1016/j.ajo.2014.05.025 pmid: 24879948
Chhablani J, Bansal P, Veritti D, Sambhana S, Sarao V, Pichi F, et al. Dexamethasone implant in diabetic macular edema in real-life situations. Eye (Lond). 2016;30(3):426-30. doi: 10.1038/eye.2015.246 pmid: 26611849
Green-Simms AE, Ekdawi NS, Bakri SJ. Survey of intravitreal injection techniques among retinal specialists in the United States. Am J Ophthalmol. 2011;151(2):329-32. doi: 10.1016/j.ajo.2010.08.039 pmid: 21168821
- Abstract Viewed: 516 times
- Full Text PDF Downloaded: 391 times