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Additional information provided in d.9., h.3., h.6.And h.11.The lens was returned in the well area of the #78(iw) lens case.A small amount of viscoelastic was observed on the lens.The lens was returned in two pieces, adhered to each other.The lens was cleaned with klrp.The lens had been cut across the center.The optic had a scratch on the posterior surface perpendicular to the travel path.The optic also had a scrape mark near one gusset area.Forcep prints were also observed at the edge which appeared to be removal damage.The used company cartridge was returned.Inadequate viscoelastic was observed in the cartridge.The tip had a large aneurysm on the left side and heavy stress lines.The cartridge had evidence of placement into a handpiece.The company cartridge was cleaned for further evaluation.Top coat dye stain testing was conducted with acceptable results.A qualified cartridge and handpiece were indicated.It is unknown if a qualified viscoelastic was used.The root cause for the reported issue appears to be related to a failure to follow the instructions for use (ifu).The optic had a scratch on the posterior surface perpendicular to the travel path.The optic also had a scrape mark near one gusset area.Inadequate viscoelastic was observed in the cartridge.The cartridge tip had a large aneurysm on the left side and heavy stress lines.This would indicate the lens/plunger were not in acceptable positions for advancement.The ifu instructs: company foldable iols are qualified for use with a company qualified delivery system (handpiece and cartridge) and ophthalmic viscosurgical device (ovd) combination.The ifu instructs that a company qualified delivery system and viscoelastic combination should be used.The use of an unqualified combination may cause damage to the lens and potential complications during the implantation process.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 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 ½ 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).
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