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A physician reported that during an intraocular lens (iol) implant procedure, observed scratch in paracentral area was probably caused by plunger.Also, lens had scratch on center.The cartridge was cracked.The iol was explanted.Additional information has been requested.
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Additional information provided in d.3., h.3., h.6.And h.11.The lens was returned position incorrectly int the lens case.A small amount of viscoelastic was observed on the lens.One haptic tip was broken-not returned.The lens was cut into two pieces across the center.The pieces were returned adhered to each other.The lens was cleaned with klrp to separate the pieces.The optic was cracked on the anterior surface near the edge, scrape marks were visible across the cracked area.The optic was also scraped/scratched on the anterior surface at one gusset area.The optic had a chipped area on the edge, which appear to have been caused by an instrument used to grasp the lens.Qualified associated products were indicated.The root cause for the lens damage appears to be related to a failure to follow the (instructions for use) ifu.The lens was damaged at the gusset area and near the edge on the anterior surface of the optic.Damage to the anterior surface may be caused by forceps or a plunger override.The returned cartridge did not exhibit adequate viscoelastic.The ifu instructs to completely fill the cartridge with ovd immediately prior to loading and delivery of the lens.Do not attempt to load the lens without adequate ovd in the device.Not adequately filling the device with viscoelastic will result in inadequate coverage of lens and the lens fold path with ovd, which may result in damage.The damage to the lens may indicate a plunger override occurred.The ifu instructs: using holding forceps, grasp the lens by the optic edge and gently place the lens anterior side up into the back of the ovd-filled cartridge.The lens should be inserted until the optic is a little more than half-way inside the cartridge.Use the holding forceps to gently push down on the lens, verifying that the lens is on the bottom surface of the cartridge.Using holding forceps, take the trailing haptic, and gently fold the haptic onto the anterior side of the optic.Slowly grip or push the optic edge to position the lens as far into the cartridge as the forceps will permit, while ensuring the lens remains on the bottom surface of the cartridge and the trailing haptic remains on the optic.Failure to follow these steps may cause the lens to advance incorrectly causing delivery issues and/or damage.Important: the plunger should make initial contact with the cartridge at the ramp.In the event the plunger does not contact the cartridge at the ramp, do not use the handpiece and contact company.The handpiece ifu instructs: verify that the plunger tip is properly engaging the lens optic and that the lens moves forward at the same rate as the plunger while slowly advancing the plunger forward to avoid damaging the lens.When the threads on the knob make contact with the barrel, turn the knob clockwise approximately half turn to engage the threads and then stop.The iol will now be in the dwell position.Inspect to ensure the plunger is behind the optic.The manufacturer internal reference number is: (b)(4).H.10 reflects all related report numbers associated with this product event that have been submitted at this time.
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