Mine KARAHAN, Seyfettin ERDEM, Sedat AVA, Mehmet Emin DURSUN, Zülküf KARAHAN, Atılım Armağan DEMİRTAŞ, Uğur KEKLİKÇİ

Yaş Tip Senil Maküla Dejeneresansı Olan Hastalarda İntravitreal Enjeksiyonun Okülokardiak Refleks Üzerine Etkisi

Amaç: Kliniğimizde yaş tip senil maküla dejeneresansı (SMD) olan hastalarda intravitreal enjeksiyonun (İVE)okülokardiak reflex (OKR) gelişimi ve kan basıncı değişikliklerine etkisini analiz etmeyi amaçladık.Yöntemler: Nisan 2018 ile Eylül 2019 tarihleri arasında X kliniğinde İVE yapılan 55 hastanın dosyaları retrospektif olarakincelendi. Hastaların takip muayene bulguları ve demografik verileri incelenip kaydedildi. Hastaların enjeksiyon öncesive enjeksiyon sırasında sistolik ve diyastolik kan basıncı, kalp atım hızı ve ritim değişiklikleri kaydedildi.Bulgular: Çalışmaya alınan 55 hastanın 30’unun (%54,5) erkek, 25‘inin (%45,5) ise kadın olduğunu saptadık. Hastalardaortalama yaş 66.67±7.39 (40-91) olarak saptandı. Hastaların 4’ünde (%7,3) kalp atım hızında %20 oranında düşüşizlenirken, 11’inde (%20,0) kalp atım hızında %10 oranında düşüş izlendi. 2 (%3,6) hastada supraventiküler taşikardigözlendi. Ortalama sistolik kan basıncında 129 mmHg‘dan 133 mmHg‘a arttığı izlenirken, ortalama diastolik kanbasıncında 76 mmHg’dan 79 mmHg’a artmış olduğu izlendi. İVE’e bağlı olarak hastalarımızdan 5’inde (%9) sistolik kanbasıncının 180 mmHg veya üzeri olduğu, 4 hastada (%7,2) diastolik kan basıncının 110 mmHg veya üzeri olduğu izlendi.Ortalama kalp hızının 85’ten 84’e düştüğü belirlendi.Sonuç: Çalışmamızda ortalama kalp hızında azalma ile ortalama sistolik ve diastolik kan basıncında artış izlendi. İVEişlemi, kan basıncında geçici artış ile ilişkili olabileceği gibi OKR gelişimine sebep olabilmektedir. Bu değişiklikler tedavisırasında kardiyovasküler veya serebrovasküler komplikasyonlar açısından risk faktörü oluşturabilir ve özellikle yüksekrisk altındaki hastalarda önemli olabilir.

The Effect Of Intravitreal Injecton On Oculocardiac Reflex In Patients With Wet-Type Senile Macular Degeneration

Objective: We aimed to analyze the effect of intravitreal injection (IVI) on oculocardiac reflex (OCR) development and blood pressure changes in patients with age-type senile macular degeneration (SMD) in our clinic. Methods: The records of 55 patients who underwent IVI at X Clinic between April 2018 and September 2019 were reviewed retrospectively. Demographic data of the patients were examined and recorded. Cystolic and diastolic blood pressure, heart rate and rhythm changes were recorded before and during the injection. Results: We dedected that 30 (54.5%) of 55 patients were male and 25 (45.5%) were female. The mean age was 66.67 ± 7.39 (40-91) years. Heart rate decreased by 20% in 4 patients (7.3%), while heart rate decreased by 10% in 11 patients (20.0%). Supraventicular tachycardia was observed in 2 (3.6%) patients. Mean systolic blood pressure increased from 129 mmHg to 133 mmHg, while mean diastolic blood pressure increased from 76 mmHg to 79 mmHg. Due to IVE, in 5 (9%) of our patients, systolic blood pressure was 180 mmHg or more, and in 4 patients (7.2%) diastolic blood pressure was 110 mmHg or more. Average heart rate was reduced from 85 to 84. Conclusions: We detected mean decrease in heart rate and an increase in mean systolic and diastolic blood pressure. IVI procedure may be associated with transient increase in blood pressure or may cause OCR development. These changes may be a risk factor for cardiovascular or cerebrovascular complications during treatment and may be particularly important in high-risk patients.

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1. Waldschmidt B, Gordon N. Anesthesia for pediatric ophthalmologic surgery. J AAPOS [Internet]. 2019 Jun; 23: 127–31.
2. Dunphy L, Anand P. Paediatric orbital trapdoor fracture misdiagnosed as a head injury: A cautionary tale! BMJ Case Rep [Internet]. 2019 Apr 3; 12: e228739.
3. Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol. 2019 Dec 14; 19: 36.
4. Alexander JP. Reflex disturbances of cardiac rhythm during ophthalmic surgery. Br J Ophthalmol. 1975 Sep 1; 59: 518–24.
5. Allen LE, Sudesh S, Sandramouli S, et al. The association between the oculocardiac reflex and post-operative vomiting in children undergoing strabismus surgery. Eye . 1998; 12: 193–6.
6. BOR C, ÇERTUĞ A. Oftalmik cerrahide anestezi. Ege Tıp Derg. 2015; 54: 46–53.
7. Ginsburg RN, Cartwright MJ, Murad SS, Nelson CC. Oculocardiac reflex in the anophthalmic socket. Ophthalmic Surg. 1992; 23: 135–7.
8. Apt L, Isenberg S, Gaffney WL. The oculocardiac reflex in strabismus surgery. Am J Ophthalmol. 1973; 76: 533–6.
9. Lai YH, Hsu HT, Wang HZ, Cheng KI, Wu KY. The oculocardiac reflex during strabismus surgery: Its relationship to preoperative clinical eye findings and subsequent postoperative emesis. J AAPOS. 2014; 18: 151–5.
10. Thylefors B. A global initiative for the elimination of avoidable blindness. Indian J Ophthalmol. 1998; 46: 129–30.
11. Hawkins BS, Fine SL, Donald J, Gass M. Argon Laser Photocoagulation for Neovascular Maculopathy: Three-year Results From Randomized Clinical Trials. Arch Ophthalmol. 1986; 104: 694–701.
12. Brown DM, Nguyen QD, Marcus DM, et al. Long-term outcomes of ranibizumab therapy for diabetic macular edema: The 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013 Oct; 120: 2013–22.
13. Ng EWM, Adamis AP. Targeting angiogenesis, the underlying disorder in neovascular age-related macular degeneration. Can J Ophthalmol. 2005 Jun; 40: 352–68.
14. Ferrara N, Damico L, Shams N, Lowman H, Kim R. Development of ranibizumab, an antivascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina. 2006; 26: 859–70. 2
15. Scappaticci FA, Skillings JR, Holden SN, , et al. Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst. 2007; 99: 1232–9.
16. Huang H, Zheng Y, Zhu J, et al. An updated meta-analysis of fatal adverse events caused by bevacizumab therapy in cancer patients. Lafrenie R, editor. PLoS One. 2014; 9: e89960.
17. Berger V, Munk MR, Lersch F, et al. Association of Intravitreal Injections with Blood Pressure Increase: The Following Excitement and Anxiety Response under Intravitreal Injection Study. JAMA Ophthalmol. 2019; 137: 87–90.
18. Serap Özden, Ülkü Çeliker, Hüseyin Çeliker Na. Oküler Cerrahide Okülokardiak Refleks. Turkiye Klin J Ophthalmol. 1993; 2: 88–91.
19. Kayikçioǧlu Ö, Kayikçioǧlu M, Erakgün T, Güler C. Electrocardiographic changes during subconjunctival injections. Int Ophthalmol. 1999; 23: 37–41.
20. Erakgün T, Ünsal E, Eğrilmez S, menteş J, Akkın C. The Oculocardiac Reflex İn Intravitreal Gas Injection Under Topical Anesthesia. T.Oft.Gaz.2002: 32: 791-795.
21. Dornberger I, Quast D, Velhagen KH, Bellach J, Guckler A. The oculocardiac reflex during vitrectomy under neuroleptanalgesia. Anaesthesiol Reanim. 1991; 16: 94–106.
22. Matarasso A. The oculocardiac reflex in blepharoplasty surgery. Plast Reconstr Surg. 1989; 83: 243–8.
23. Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg. 1999; 90: 215–20.