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Steven Ryder, Gary Lelli; Factors Influencing The Oculocardiac Reflex During Enucleation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):737.
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The oculocardiac reflex (OCR) is a well-known complication of surgery involving direct or indirect manipulation of the orbit or orbital contents. While most commonly associated with eye muscle surgery, it is prevalent during enucleation procedures and may manifest as a wide range of arrhythmias including bigeminy, bradycardia and asystole. Based on prior studies, the reported incidence of the OCR during eye muscle surgery has varied widely, from 14% to 90%. Occurrence of the reflex in eye muscle surgery has been documented to increase with hypoxia and decrease with aging and premedication with anticholinergics, namely glycopyrrolate or atropine. There remains a paucity of literature on factors influencing the OCR during enucleation.
We performed a retrospective case series reviewing the records of patients undergoing an enucleation procedure, with or without implants, at Weill Cornell Eye from October 2008 to October 2012. Fourteen patients met criteria and were evaluated based on age, gender, body mass index, preoperative vital signs (systolic and diastolic blood pressure, heart rate and blood oxygen saturation), as well as preoperative and intraoperative anesthesia. Data was analyzed using paired two-tailed t-tests.
The oculocardiac reflex, in the form of profound bradycardia, was reported in one of the fourteen patients (7.14%) undergoing enucleation surgery. There was no demonstrable difference between the two groups based on age (p = 0.43), gender (p = 0.12), body mass index (p = 0.72), preoperative systolic blood pressure (p = 0.82), preoperative diastolic blood pressure (p = 0.60), heart rate (p = 0.75), preoperative blood oxygen saturation (p = 0.51), lowest intraoperative blood oxygen saturation (p = 0.84) or premedication with 0.2 mg IV glycopyrrolate (p = 0.12).
The oculocardiac reflex possesses the potential for significant morbidity and mortality. While some have documented factors affecting the OCR during eye muscle surgery, our data could not prove such a relationship during enucleation. The lack of statistical significance in our study was likely the result of a small sample size. Further research will prove beneficial in this area.
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