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The reference (b)(4) has been allocated to this case by rayner.The event description provided states that immediately following implantation into the eye the lens was identified to be scratched.The lens was explanted and exchanged during the original surgery session without further incident."iol replacement or extraction" is listed in the "adverse events" section of the rayone ifu.The device was discarded by the healthcare facility.The rayner hydrophilic acrylic iol use risk matrix identifies the following as possible causes of "physical damage to lens": sharp edge instruments used during surgical procedure, surgical procedure: incorrect use of lens injection system, surgeon misidentifying posterior capsule creasing, lens surface ablated by nd: yag operator error and cracked optic surface post injection due to dehydration of lens.Additionally, the rayone preloaded iol injection system use risk matrix identifies forcing a blocked injector, inadequate lubrication, misuse of device and optic edge trapped/damaged on closure of cartridge as possible causes of lens optic damage.The additional information received identifies that the surgeon does not use ovd and instead uses a hydroimplantation technique.The ifu states "rayner recommends that saline is not used as the sole lubricating agent, but in combination with a viscoelastic solution.The use of a sodium hyaluronate-based viscoelastic is recommended." our review of production records for the rayone spheric rao100c batch 095280275 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 spheric rao100c batch 095280275.The lack of ovd use, a deviation from the ifu, may be a contributory and/or causative factor to the lens damage in this case.
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