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Ophthalmic Images
March 10, 2016

Overestimation of Intraocular Pressure by Goldmann Applanation Tonometry Without Astigmatic Correction

Author Affiliations
  • 1St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, England
  • 2Department of Eye and Vision Science, University of Liverpool, England
JAMA Ophthalmol. 2016;134(3):e153691. doi:10.1001/jamaophthalmol.2015.3691

A man in his mid-50s underwent 2 successive emergency penetrating keratoplasties for Candidal keratitis in his left eye. Significant postoperative astigmatism (K1 = 34.7@117, K2 = 45.2@27) led to marked overestimation of the intraocular pressure (56 mm Hg) as measured with Goldmann applanation tonometry with the mires in the standard horizontal position (Figure, A). With astigmatic correction, rotating the mires to 43° with respect to the more weakly refracting meridian,1 the pressure measured 20 mm Hg (Figure, B), which was confirmed by rebound tonometry (17 mm Hg).

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