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The device was returned inside the blister tray.The lens stop and plunger lock were removed.The plunger was oriented correctly.Viscoelastic was observed in the device.The plunger was in contact with the trailing optic edge.The plunger has advanced the lens toward mid-nozzle.The leading haptic was folded onto the anterior optic surface.The trailing haptic was extended back along the left side of the plunger with the distal area folded over top the plunger.The nozzle was removed and cleaned for further evaluation.Top coat dye stain testing was conducted with acceptable results.A non-qualified viscoelastic was indicated.The trailing haptic was extended back along the left side of the plunger and over top the plunger.This was most likely interpreted as the reported complaint.The root cause may be related to a failure to follow the instructions for use (ifu).A non-qualified viscoelastic was indicated.The ifu instructs: during device preparation and implantation of the company provided intraocular lens (iol) with the company provided preloaded delivery system, a company provided qualified ophthalmic viscoelastic device (ovd) should be used.The use of an unqualified ovd may cause damage to the lens and potential complications during the device preparation and implantation steps.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.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.A diagram is provided which indicates a straight trailing haptic is not acceptable for delivery and the device should not be used.Proceeding with implantation of a misfolded trailing 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 trailing haptic may become stuck: ¿ if the plunger is not fully advanced the haptic may not release properly from the device ¿ due to the use of a non-qualified viscoelastic.Material properties of non-qualified ovds may contribute to underfill, overfill, misfolding of the haptics, or other inconsistent folding outcomes.¿ if the operating room temperature is too high (> 23°c / 73° f) lens folding consistency is negatively affected, the lens is more adherent, and this may inhibit lens advancement.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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