CB MICROKERATOME 19303

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,06 report with the FDA on 2014-02-04 for CB MICROKERATOME 19303 manufactured by Moria Sa.

Event Text Entries

[4350647] The patient underwent a bilateral lasik surgery in which a moria cb manual microkeratome had been used. The surgery took place in (b)(6) 2004 in (b)(6). At 15 months later, the patient declared a double keratectasia. One in each eye. The only information we have is what was mentioned in a judicial assignment received on january 7, 2014: "the stroma residual thickness is too thin and is at the origin of the bilateral keratectasia. "
Patient Sequence No: 1, Text Type: D, B5


[11649770] The facility, (b)(6), where the surgery was performed, purchased the device in (december 2001). Based on the info available to moria, it appears that the pt underwent lasik surgery on both eyes on (b)(6) 2004. This type of surgery involves different medical devices, including a microkeratome, which is a surgical instrument that cuts the flap in the cornea during the surgery, as well as an excimer laser that is used to reshape the cornea after the flap is pulled back. Moria's cb microkeratome was used in the procedure in question. Approx 15 months after the lasik procedure, the pt reported development of a keratectasia (i. E. , abnormal bulging of the cornea) in each eye. Keratectasia is most commonly treated with the use of corrective contact lenses; in some instances, however, penetrating keratoplasty is required to correct the condition (with a high rate of success). Moria first learned of this incident on 01/7/2014 when it was notified of a liability case brought in (b)(4) by the pt against the physician who performed the procedure. The only info available to moria about the potential cause of the keractasia is the allegation that "[t]he stroma residual thickness is too thin and is at the origin of the bilateral keratectasia. " however, there is no evidence that the thickness or thinness of the stroma was affected by the microkeratome or that development of a keratectasia was otherwise attributable to the use of the cb microkeratome. Other non-moria equipment (e. G. , excimer laser) is also used during the procedure and that or other factors could have caused the thinness of the stroma. Clinique dur meridien, the facility where the surgery was performed, bought the device from moria in december 2001 and, to moria's knowledge, began using the equipment in january 2002. At the time of purchase, the facility also purchased four sets of replacement parts for the equipment and moria has no record of any similar incidents occurring at this facility. Moria regards this as an isolated incident. However, based on the info available to it, moria does not believe that the incident was caused by any malfunction or defect in the cb microkeratome or that the microkeratome in any other way caused or contributed to the outcome of this surgery. As moria does not believe that the incident was caused or contributed to by the device, this report is submitted out of an abundance of caution an only because the pt alleged a serious injury that appears to have required a corrective procedure to prevent permanent impairment of the pt's vision.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number9615659-2014-00001
MDR Report Key3641100
Report Source01,06
Date Received2014-02-04
Date of Report2014-01-21
Date of Event2004-10-01
Date Mfgr Received2014-01-07
Date Added to Maude2014-02-25
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer Street1050 CROSS KEYS DRIVE
Manufacturer CityDOYLESTOWN PA 18902
Manufacturer CountryUS
Manufacturer Postal18902
Manufacturer Phone2152307662
Manufacturer G1MORIA SA
Manufacturer Street15 RUE GEORGES BESSE
Manufacturer CityANTONY 92160
Manufacturer CountryFR
Manufacturer Postal Code92160
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCB MICROKERATOME
Generic NameKERATOME
Product CodeHMY
Date Received2014-02-04
Model Number19303
Catalog Number19303
Lot NumberUNK
ID NumberNA
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerMORIA SA
Manufacturer AddressANTONY FR


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2014-02-04

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