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A physician reported that during an intraocular lens (iol) implant procedure, the iol plunger incorrectly positioned the lens in the narrow part of the cartridge, which led to entrapment and detachment of the haptic element, as well as damage to a section of the optical part of the iol during its exit from the device.Company viscoelastic was used at all stages of the procedure.The surgery was completed with the backup company lens of same diopter.There were no patient contact and no patient harm.
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Correction: on initial mdr, the product code a0502 had to be submitted.Additional information has been provided in h.3., and h.11.The sample was not returned.A photo was provided of an ungloved hand holding the carton.The end cap with the product information was facing the camera.The used device was placed on its side with the posterior facing the camera.The lens stop and plunger lock were removed from the device.The plunger appeared to be retracted toward mid-nozzle.The image was blurry, but a damaged portion of the yellow lens model was observed in the tip of the device.The remainder of the lens was located outside the device.One haptic and a portion of the optic material were observed to be broken.The image was too blurry in order to determine the amount of viscoelastic present in the device.Device history record review and a non-conformance review of the reported lot number was conducted.The deviation review did not reveal any potential contributing factors to the reported complaint and all corresponding production release specifications defined in the device master record were met.A qualified viscoelastic was used.Based on our observation of the attached photo, the haptic and a portion of the optic was broken.The presence of clinical solution on the lens cannot be determined.It is difficult to make a determination of handling / damage without evaluation of the physical sample.A final root cause cannot be determined based on available information.The trailing haptic position may not have been in a proper position for advancement per the provided diagrams in the ifu.The ifu instructs: after the lens has been advanced to the fill-to line, the lens should be visually inspected to determine the position of the haptics.The plunger should be in contact with the trailing optic edge.No part of the lens should exit the nozzle prior to insertion through the incision.Once the lens is in position at the fill-to line, it should be implanted within 3 minutes.Proceeding with implantation of a misfolded haptic or a lens that appears to be out of position can result in a broken haptic or other negative outcome, since the haptic may be trapped and stretched, and/or pinched and sheared by the moving plunger.The ifu instructs: fully insert the 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 ml of ovd.Only use a company ovd qualified for use with the company delivery system that has been allowed to come to the operating room temperature.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.The ifu instructs: take at least 7 seconds to gently fold the iol by advancing the plunger forward in one smooth, continuous motion until the front edge of the optic is even with the fill-to line on the nozzle.Do not allow any portion of the lens to exit the nozzle tip.At this position the blue spring will contact the clear main body.It is important to not advance the plunger abruptly to fold the iol as improper folding and lens damage may occur.Broken haptics may occur: if the operating room temperature is too high (> 23 degree c / 73 degree f) lens folding consistency is negatively affected, the lens is more adherent and this may inhibit lens advancement.In addition, haptic strength (modulus) decreases as the temperature increases and is more likely to break under stress.If the device is overfilled with ovd as this can prevent the trailing haptic from being placed properly or move the lens out of position resulting in misfolding.If a straight trailing haptic occurs and it was not properly detected to be out of position.If the plunger is not fully advanced, or if the plunger is allowed to retract, the trailing haptic may not release properly from the device.Any of the above listed causes alone, or in combination, may create the reported event.The manufacturer internal reference number is: (b)(4).
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