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Ocular Palpation in Pseudophakia
Vol. 104, No. 3
Letters to the Journal
307
there was no doubt that the eye was extremely soft, with a pressure certainly less than 5 mm Hg. Because of the inconsistency, each measurement was checked by two additional observers. The applanating surface of the Goldmann tonometer is 3.06 mm 2 , indents less than 0.2 mm, displaces 0.5 ml of aqueous, and increases intraocular pressure approximately 3%.' Pneumatonometry also indents the eye and is subject to many of the same limitations as Goldmann tonometry. In this case, a soft eye was erroneously believed to have an increased intraocular pressure. We propose that applanation and pneumatonometry, by slight indentation, caused contact between the cornea and the anterior chamber lens. Thus, we may have measured the resilience of the lens haptics rather than the Ocular Palpation in Pseudophakia intraocular pressure. Robert M. Feldman, M . D . , In cases of anterior chamber pseudophakia L. Jay Katz, M . D . , and very shallow anterior chambers, applanation and pneumatonometry are fallible. This George L. Spaeth, M . D . , error may become more frequent as increasing Ronald L. Gross, M . D . , numbers of corneal transplants with anterior and Rohit Varma, M . D . reconstruction are performed. In these cases Glaucoma Service, Wills Eye Hospital. ocular palpation may provide useful informaInquiries to George L. Spaeth, M.D., Wills Eye Hospital, tion. 9th and Walnut Sts., Philadelphia, PA 19107. Goldmann applanation tonometry is the most common method of intraocular pressure Reference measurement. After keratoplasty, corneal surface irregularities may induce error into Goldmann tonometry. Pneumatonometry is often 1. Brubaker, R. F.: Tonometry. In Duane, T., and Jaeger, E. (eds.): Clinical Ophthalmology. Philadelthe alternative. Despite accurate measurephia, Harper and Row, 1985, p. 2. ments in cases of corneal irregularity, we encountered a case where significant errors in pneumatonometry, as well as Goldmann tonometry, were found. A 69-year-old woman underwent penetrating keratoplasty for a corneal ulcer. A previous Disinfectant Receptacle for anterior chamber implant was left untouched. Applanation Tonometers Postoperatively she developed severe angleclosure glaucoma, necessitating trabeculecE. Michael Van Buskirk, M . D . tomy. This was unsuccessful and cyclocryoDepartment of Ophthalmology, Oregon Health Scitherapy was then performed. Six weeks later ences University. her intraocular pressure (the patient was taking dipivifrin and pilocarpine) as measured by Inquiries to E. Michael Van Buskirk, M.D., 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201. Goldmann applanation tonometry was 28 mm Hg. However, this pressure measurement was The acquired immune deficiency syndrome too high for an eye displaying characteristics of and the recent isolation of human Tsevere glaucomatous optic nerve damage. The lymphotrophic virus type III from human concornea had an irregular appearance, typical of junctiva and tears has renewed interest in office an extremely soft eye. The intraocular lens was sterilization of applanation tonometers and in close proximity to the posterior surface of the other ophthalmic instruments. 1 2 Although ungraft. Yet increased pressure was confirmed by likely, it is possible for viral organisms to surpneumatonometry. Upon manual palpation, vive on the drying tonometer tip and thus be ulcers following patching of corneal abrasions associated with contact lens wear. CLAO 13:161, 1987. 3. Wilson, L. A., Schlitzer, R. L., and Ahearn, D. G.: Pseudomonas corneal ulcers associated with soft contact lens wear. Am. J. Ophthalmol. 92:546, 1981. 4. Atkinson, B. A.: Species incidence, trends of susceptibility to antibiotics in the US, and minimum inhibitory concentration. In Lorian, V. (ed.): Antibiotics in Laboratory Medicine. Baltimore, Williams and Wilkins, 1980, pp. 607-722. 5. Bryan, L. E: Mechanisms of action of aminoglycoside antibiotics. In Root, R. K., and Sande, M. A. (eds.): New Dimensions in Antimicrobial Therapy. New York, Churchill Livingstone, 1984, pp. 17-36.
Letters to the Journal
307
there was no doubt that the eye was extremely soft, with a pressure certainly less than 5 mm Hg. Because of the inconsistency, each measurement was checked by two additional observers. The applanating surface of the Goldmann tonometer is 3.06 mm 2 , indents less than 0.2 mm, displaces 0.5 ml of aqueous, and increases intraocular pressure approximately 3%.' Pneumatonometry also indents the eye and is subject to many of the same limitations as Goldmann tonometry. In this case, a soft eye was erroneously believed to have an increased intraocular pressure. We propose that applanation and pneumatonometry, by slight indentation, caused contact between the cornea and the anterior chamber lens. Thus, we may have measured the resilience of the lens haptics rather than the Ocular Palpation in Pseudophakia intraocular pressure. Robert M. Feldman, M . D . , In cases of anterior chamber pseudophakia L. Jay Katz, M . D . , and very shallow anterior chambers, applanation and pneumatonometry are fallible. This George L. Spaeth, M . D . , error may become more frequent as increasing Ronald L. Gross, M . D . , numbers of corneal transplants with anterior and Rohit Varma, M . D . reconstruction are performed. In these cases Glaucoma Service, Wills Eye Hospital. ocular palpation may provide useful informaInquiries to George L. Spaeth, M.D., Wills Eye Hospital, tion. 9th and Walnut Sts., Philadelphia, PA 19107. Goldmann applanation tonometry is the most common method of intraocular pressure Reference measurement. After keratoplasty, corneal surface irregularities may induce error into Goldmann tonometry. Pneumatonometry is often 1. Brubaker, R. F.: Tonometry. In Duane, T., and Jaeger, E. (eds.): Clinical Ophthalmology. Philadelthe alternative. Despite accurate measurephia, Harper and Row, 1985, p. 2. ments in cases of corneal irregularity, we encountered a case where significant errors in pneumatonometry, as well as Goldmann tonometry, were found. A 69-year-old woman underwent penetrating keratoplasty for a corneal ulcer. A previous Disinfectant Receptacle for anterior chamber implant was left untouched. Applanation Tonometers Postoperatively she developed severe angleclosure glaucoma, necessitating trabeculecE. Michael Van Buskirk, M . D . tomy. This was unsuccessful and cyclocryoDepartment of Ophthalmology, Oregon Health Scitherapy was then performed. Six weeks later ences University. her intraocular pressure (the patient was taking dipivifrin and pilocarpine) as measured by Inquiries to E. Michael Van Buskirk, M.D., 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201. Goldmann applanation tonometry was 28 mm Hg. However, this pressure measurement was The acquired immune deficiency syndrome too high for an eye displaying characteristics of and the recent isolation of human Tsevere glaucomatous optic nerve damage. The lymphotrophic virus type III from human concornea had an irregular appearance, typical of junctiva and tears has renewed interest in office an extremely soft eye. The intraocular lens was sterilization of applanation tonometers and in close proximity to the posterior surface of the other ophthalmic instruments. 1 2 Although ungraft. Yet increased pressure was confirmed by likely, it is possible for viral organisms to surpneumatonometry. Upon manual palpation, vive on the drying tonometer tip and thus be ulcers following patching of corneal abrasions associated with contact lens wear. CLAO 13:161, 1987. 3. Wilson, L. A., Schlitzer, R. L., and Ahearn, D. G.: Pseudomonas corneal ulcers associated with soft contact lens wear. Am. J. Ophthalmol. 92:546, 1981. 4. Atkinson, B. A.: Species incidence, trends of susceptibility to antibiotics in the US, and minimum inhibitory concentration. In Lorian, V. (ed.): Antibiotics in Laboratory Medicine. Baltimore, Williams and Wilkins, 1980, pp. 607-722. 5. Bryan, L. E: Mechanisms of action of aminoglycoside antibiotics. In Root, R. K., and Sande, M. A. (eds.): New Dimensions in Antimicrobial Therapy. New York, Churchill Livingstone, 1984, pp. 17-36.