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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 surgeon identified that part of the lesn optic was missing.The lens was explanted and exchanged during the original surgery session without 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 returned.The rayone preloaded iol injection system risk matrix 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 additional information received identifies that the surgeon noticed increased resistance after he began the injection.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".Continued injection of the lens at the point increased resistance was noted represents a deviation from the ifu which states injection should be discontinued.Our review of production records for the rayone emv toric rao210t batch 095281258 showed that all manufacturing and quality checks were conducted with successful results.A review of existing vigilance data confirms that this is an isolated event.No other incidents, of any type, have been reported against the rayone emv toric rao210t batch 095281258.
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