MAUDE Adverse Event Report: STAAR SURGICAL COMPANY IMPLANTABLE COLLAMER LENS (ICL); PHAKIC TORIC INTRAOCULAR LENS

Model Number VTICM5_13.2

Device Problem Inadequacy of Device Shape and/or Size (1583)

Patient Problems Inflammation (1932); Discomfort (2330); Appropriate Clinical Signs, Symptoms, Conditions Term / Code Not Available (4581)

Event Type  Injury  

Event Description

The reporter indicated the surgeon implanted a 13.2mm vticm5_13.2 implantable collamer lens, -09.00/+2.0/093 (sphere/cylinder/axis), into the patients left eye (os) on (b)(6) 2023.Shallow anterior chamber (ac) and high vault was noted.The lens remained implanted.A course of steroids was administered.Post-op, the patients ocular discomfort has mostly subsided already.Additional information has been requested but none has been forthcoming.

Manufacturer Narrative

Weight: unk.Ethnicity: unk.Race: unk.Date of event: unk.Health effect impact code: 4644 - steroids work order search: no similar complaint was reported for units within the same lot.Claim #(b)(4).

Manufacturer Narrative

Corrected data/ additional data: b5: the reporter indicated that the surgeon implanted a 13.2mm vticm5_13.2 implantable collamer lens of diopter -9.0/+2.0/093 (sphere/cylinder/axis) into the patient's left eye (os) on (b)(6) 2023.The patient experienced excessive vault, shallow ac, iris pigment loss, iris prolapse, inflammation and medication was prescribed.Reportedly "vision is great and refractive outcome is very good.However, her ac in both eyes is quite shallow.Vault is high (approx 1500-2000 micron)." and "i have started a course of steroids to counter any mild underlying inflammation".It was later reported, "shallow vault.Ucva 6/5.Clear lens.Iris pigment loss from prolapse during surgery.Iop 14".The lens remains implanted.H6: health impact code: "4614" should be added.H6: health effect- clinical code: "4581- shallow ac, iris prolapse, iris pigment loss " and "1932" should be added.Claim#: (b)(4).

• Brand Name: IMPLANTABLE COLLAMER LENS (ICL)
• Type of Device: PHAKIC TORIC INTRAOCULAR LENS
• Manufacturer (Section D): STAAR SURGICAL COMPANY; 1911 walker avenue; monrovia CA 91016
• Manufacturer (Section G): STAAR SURGICAL COMPANY; 1911 walker avenue; monrovia CA 91016
• Manufacturer Contact: joselene muniz ; 1911 walker avenue; monrovia, CA 91016 ; 6263037902
• MDR Report Key: 17704497
• MDR Text Key: 322923694
• Report Number: 2023826-2023-03871
• Device Sequence Number: 1
• Product Code: QCB
• Combination Product (y/n): N
• Reporter Country Code: UK
• PMA/PMN Number: P030016
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Health Professional,User Facility
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 08/14/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: VTICM5_13.2
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 09/07/2023
• Supplement Dates Manufacturer Received: 01/22/2024
• Supplement Dates FDA Received: 01/24/2024
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 06/09/2023
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: CARTRIDGE MODEL SFC45 - LOT # UNK.; FOAM TIP PLUNGER MODEL FTP - LOT # UNK.; INJECTOR MODEL MSI-PF - LOT # UNK.
• Patient Outcome(s): Required Intervention
• Patient Sex: Female