K Number
K023481
Device Name
MICROVISION SCLERAL BUCKLING COMPONENTS
Manufacturer
Date Cleared
2003-01-08

(83 days)

Product Code
Regulation Number
886.3340
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MicroVision Scleral Buckling Components are solid silicone and silicone sponge implants intended for intrascleral and episcleral buckling in the surgical treatment of retinal detachments.
Device Description
The MicroVision Scleral Buckling Components are molded solid silicone and silicone sponge devices available in a variety of shapes and sizes. The components are provided as sterile for single use only. Biocompatibility testing conducted according to ISO 10993 confirmed that the components are biocompatible and nontoxic.
More Information

Not Found

No
The summary describes a passive, physical implant (scleral buckling components) and does not mention any computational or analytical functions, let alone AI/ML.

Yes

Explanation: The device is intended for the "surgical treatment of retinal detachments," which is a therapeutic intervention.

No
Explanation: The device is described as an implant used for surgical treatment of retinal detachments. It does not mention any function related to diagnosing conditions or diseases.

No

The device description explicitly states the components are "solid silicone and silicone sponge implants" and "molded solid silicone and silicone sponge devices," indicating a physical hardware device.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. These tests are performed outside of the body.
  • Device Description: The MicroVision Scleral Buckling Components are described as "solid silicone and silicone sponge implants intended for intrascleral and episcleral buckling in the surgical treatment of retinal detachments."
  • Intended Use: The intended use is for surgical implantation within or on the eye to treat retinal detachments. This is a surgical procedure performed on the body, not a test performed on samples taken from the body.

The device is an implantable surgical device, not a diagnostic test.

N/A

Intended Use / Indications for Use

The MicroVision Scleral Buckling Components are solid silicone and silicone sponge implants intended for intrascleral and episcleral buckling in the surgical treatment of retinal detachments.

Product codes

HQX

Device Description

The MicroVision Scleral Buckling Components are molded solid silicone and silicone sponge devices available in a variety of shapes and sizes. The components are provided as sterile for single use only. Biocompatibility testing conducted according to ISO 10993 confirmed that the components are biocompatible and nontoxic.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Bench testing was conducted to demonstrate that the MicroVision products are substantially equivalent to the predicates with respect to dimensional and physical properties.

Key Metrics

Not Found

Predicate Device(s)

K950806, K832481, K950599, K875014

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 886.3340 Extraocular orbital implant.

(a)
Identification. An extraocular orbital implant is a nonabsorbable device intended to be implanted during scleral surgery for buckling or building up the floor of the eye, usually in conjunction with retinal reattachment. Injectable substances are excluded.(b)
Classification. Class II.

0

KO23481

510(k) Summary

for

MicroVision Scleral Buckling Components

1. SPONSOR

MicroVision, Inc. 34 Folly Mill Road, Suite 200 P.O. Box 1651 Seabrook, NH 03874

Contact Person: Leonard Kastrilevich 603-474-5566 Telephone:

Date Prepared: October 16, 2002

2. DEVICE NAME

Proprietary Name:MicroVision Scleral Buckling Components
Common/Usual Name:Scleral Buckling Components
Classification Name:Nonresorbable Extraocular Orbital Implants

3. PREDICATE DEVICES

MicroVision, Inc. claims substantial equivalence to the solid silicone and silicone sponge implants cleared for marketing under the following 510(k)s:

INTENDED USE 4.

The MicroVision Scleral Buckling Components are solid silicone and silicone sponge implants intended for intrascleral and episcleral buckling in the surgical treatment of retinal detachments.

5. DEVICE DESCRIPTION

The MicroVision Scleral Buckling Components are molded solid silicone and silicone sponge devices available in a variety of shapes and sizes. The components

1

KO23481

are provided as sterile for single use only. Biocompatibility testing conducted according to ISO 10993 confirmed that the components are biocompatible and nontoxic.

BASIS FOR SUBSTANTIAL EQUIVALENCE 6.

The MicroVision Scleral Buckling Components have the same intended use as the listed predicate products, that is, for scleral buckling in retinal reattachment surgery. All of the products are made of molded silicone, either in solid or sponge form, are provided sterile for single use only, and are available in a wide variety of shapes and sizes. All products have been demonstrated to be biocompatible and non-toxic. Bench testing was conducted to demonstrate that the MicroVision products are substantially equivalent to the predicates with respect to dimensional and physical properties.

2

Image /page/2/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around an emblem. The emblem depicts a stylized image of an eagle or bird with three curved lines representing its wings or feathers. The overall design is simple and conveys a sense of authority and professionalism.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN 0 8 2003

MicroVision, Inc. Sheila Hemeon-Heyer, JD, RAC c/o Medical Device Consultants, Inc. (MDCI) 49 Plain Street North Attleboro, MA 02760

Re: K023481

Trade Name: MicroVision Scleral Buckling Components Classification Regulation Number: 886.3340 Regulatory Class: II Product Code: HQX Dated: October 16, 2002 Received: October 17, 2002

Dear Dr. Hemeon-Heyer:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration,

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set

3

Page 2 - Sheila Hemeon-Heyer, JD, RAC

forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4692. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,
A. Ralph Rosenthal

A. Ralph Rosenthal, M.D. Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

4

510(k) Number (if known): ¥02 348 |

Device Name: MicroVision Scleral Buckling Components

Indications for Use:

The MicroVision Scleral Buckling Components are solid silicone and silicone sponge implants intended for intrascleral and episcleral buckling in the surgical treatment of retinal detachment.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NECESSARY)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Ausannand Jones

(Division Sign-Off)
Division of Ophthalmic Ear,
Nose and Throat Devises

510(k) Number K 033981

L Prescription Use (Per 21 CFR 801.109)

OR

Over-The-Counter Use

(Optional Format 1-2-96)

October 16, 2002