An update on postrefractive surgery intraocular pressure determination

PURPOSE OF REVIEW: Due to alterations in corneal structure and biomechanics, intraocular pressure (IOP) measurement after refractive surgery has questionable accuracy. Numerous devices and techniques have been evaluated in the past decade. Whereas some methods clearly underestimate postoperative IOPs, other promising leads have emerged that are less affected by laser ablative procedures. RECENT FINDINGS: It is well established that Goldmann applanation tonometry (GAT) underestimates IOP after refractive surgery. The discussion on the accuracy of different techniques of IOP measurement after refractive surgery remains ongoing. Evidence suggests that techniques that are less reliant on corneal structure and biomechanics may provide less altered IOPs postoperatively. Therefore, devices such as Dynamic Contour Tonometry and tonopen may have great utility after laser ablative surgery. SUMMARY: GAT may not be the best method of measuring IOP after refractive surgery. Other devices may be superior to the GAT in providing more accurate IOP postoperatively. It is imperative that clinicians are aware of the possible inaccuracy of IOP acquisition after refractive surgery, in order to provide optimal monitoring for the development and progression of glaucoma.