Atropine-induced lens extrusion in an open eye surgery.

A 2-month-old male baby undergoing penetrating keratoplasty (PKP) under general anesthesia developed bradycardia and a decrease in heart rate to 53 b x min(-1) when stay sutures were taken through the superior and inferior recti. A bolus of 0.1 mg intravenous atropine resulted in tachycardia of up to 180-220 b x min(-1), which persisted for 35 min. After corneal trephination was performed the eyeball seemed to pulsate with the heartbeat. Spontaneous extrusion of the lens and vitreous occurred, which necessitated a lensectomy and vitrectomy in addition to PKP. The role of atropine in corneal transplant surgery is discussed here.