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Additional information was provided in d.9., h.3., h.6.And h.11.The device with the lens was returned loose in the carton.The plunger lock and lens stop were removed.The plunger was oriented correctly.Inadequate viscoelastic was observed in the device.The plunger was advanced to mid-nozzle and has overrode the lens.The lens was advanced into the nozzle entry area.The leading haptic was extended along the right side of the plunger.The trailing haptic was folded onto the anterior optic surface.The nozzle was removed and cleaned for further evaluation.The lens was removed during cleaning.Topcoat dye stain testing was conducted with acceptable results.Product history records were reviewed, and the documentation indicated the product met release criteria.A qualified viscoelastic was indicated.The lens was at the nozzle entry due to a plunger override.The extended haptic position beside the plunger was due to the plunger override and was most likely interpreted as part of the reported complaint.The root cause may be related to a failure to follow the instructions for use (ifu).An inadequate amount of viscoelastic was observed.The ifu instructs: fully insert the ophthalmic viscosurgical device (ovd) cannula, perpendicular to the device, through the viscoelastic port, located in the lens stop portion of the device.Fill the device until ovd can be observed flowing to the "fill-to" line on the nozzle tip.This will require approximately 0.2 milliliters (ml) of ovd.Only use a company ovd qualified for use with the company pre-loaded delivery system that has been allowed to come to the operating room temperature.Plunger override may occur: due to rapid advancement faster than the ifu recommended rate.If inadequate viscoelastic is placed in the device, this will cause inadequate coverage of the lens fold path which may cause the lens to advance incorrectly or become "stuck" in the device allowing the plunger to override the lens.If the operating room temperature is too high (greater than 23 degrees centigrade / 73 degrees fahrenheit) lens folding consistency is negatively affected, the lens is more adherent and this may inhibit lens advancement.Any of the above listed causes alone, or in combination, may create the reported event.Topcoat dye stain testing was conducted with acceptable results.The manufacturer internal reference number is: (b)(4).
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