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The reference (b)(4) has been allocated to this case by rayner.The event description provided states that there was some resistance during injection and on delivery into the eye one haptic was broken.The lens was explanted and exchanged within the original surgery session.Surgery is reported to have been more complex and prolonged due to the event; however, it has been verified that there was no harm or injury to the patient."iol replacement or extraction" is listed in the "adverse events" section of the rayone ifu.The device was not available for return to rayner.The rayone preloaded iol injection system use risk analysis identifies the following as possible causes of "trapped/ torn lens haptic/ optic during insertion"; inadequate amount of viscoelastic; inadequate quality of viscoelastic; haptic trapped by plunger override due to fast motion; user opens closed flaps and closes again before use; plunger advanced too quickly, insertion of viscoelastic through nozzle leading to inadequate amount of viscoelastic; user removed injector from tray prior to inserting viscoelastic, causing lens to be improperly placed in cartridge; user removed injector from tray prior to closing cartridge, resulting in cartridge not being clipped properly; optic edge trapped/ damaged on closure of cartridge, sharp edge instruments and dehydration of the lens prior to implantation.The rayone ifu "use of rayone" section "fig 7" states "press the plunger in a slow and controlled manner.If excessive resistance is felt this could indicate a blockage; discontinue use of the product and return the product and all packaging to rayner".Our review of production records for the rayone aspheric rao600c, batch 045268778 showed that all manufacturing and quality checks were conducted with successful results.A review of vigilance data confirms this is an isolated event.No other incidents, of any type, have been received against the rayone aspheric rao600c, batch 045268778.The verbatim report of resistance during injection could indicate that the lens had become trapped in the injector and that continued injection of the lens has resulted in the lens being delivered into the eye in a damaged condition (as reported); however, without the abiltiy to examine the device and without clear event details being provided it is not possible to establish the root cause of the event.
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