K Number
K182646
Manufacturer
Date Cleared
2019-05-01

(219 days)

Product Code
Regulation Number
886.4690
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

VitreQ Disposable Laser Probes, 90° Directional Laser Probes and 90° Directional Illuminated Laser Probes are intended for use in vitreoretinal surgery to perform endo-ocular laser photocoagulation treatments at operating wavelengths of 500nm to 900nm.

The 90° Directional Illuminated Laser Probes, Light Fibers and Chandelier are for illumination during ophthalmic surgery and should only be used with the light wavelength range of 425nm to 700mm.

Device Description

The VitreQ Disposable Laser Probe is an ophthalmic instrument, which is used in posterior segment eye surgery and is appropriate for photocoagulation. The device can be connected to an ophthalmic laser generator, which is not a part of this application.

The VitreQ Disposable Laser Probe is introduced into the posterior segment of the eye through an incision or an ophthalmic entry port, after the vitreous is removed during vitreoretinal surgery.

The Disposable Laser Probe guides the laser energy to the intended surgical site to provide photocoagulation treatment. The laser enerqy intensity or power output is not controlled, altered or significantly reduced by the disposable laser probe. The laser spot size on the target tissue can be varied by altering the distance between the tissue and the probe tip.

To reach the target tissue in the periphery section of the 90° Directional Laser Probe tip can be directed due to bending the metal tip. The angle of the tip in the most directed position is about 90°. An angled laser probe reduces the need of a strong indentation of the eye and is intended to prevent accidently touching the crystal lens.

The VitreQ Disposable Laser Probes, 90° Directional Laser Probes and (90°) Directional Illuminated Laser Probes are constructed with an optical laser connector, a glass fiber optic covered by a protective sheath and one handle for surgeon manipulation, metal tubing is extending from the handle which penetrates the surgical site. The device is intended for singleuse only.

The VitreQ Disposable Laser Probes can only be used with a medical laser at an operating wavelength range of 500nm to 900nm.

For the VitreQ Disposable Laser Probes, (90°) Directional Illuminated Laser Probe the functionality is combined with illumination. To achieve the illumination of the surgical site, the probe is constructed with an additional plastic fiber, which has a connector to attach the fiber to an ophthalmic light source, which is not a part of this application.

The VitreQ Disposable Light Fibers are constructed with a handle, the plastic illumination fiber, and the connector to attach the fiber to an ophthalmic light source. To match the connection to the ophthalmic light source, there are several reusable light source adaptors available.

The VitreQ (90°) Directional Illuminated Laser Probes, Light Fibers and Chandelier can only be used with the light wavelength range of 425nm to 700nm.

AI/ML Overview

This document is a 510(k) Pre-Market Notification from Vitreq B.V. for their Disposable Laser Probes, Light Fibers, and Chandelier. It seeks to demonstrate substantial equivalence to previously cleared predicate devices.

Here's an analysis of the provided information regarding acceptance criteria and performance studies:

1. A table of acceptance criteria and the reported device performance:

The document doesn't explicitly present a formal "acceptance criteria" table with corresponding numerical performance results in the format requested. Instead, it describes performance characteristics and compares them to the predicate device, emphasizing substantial equivalence.

Based on the "Summary of technological characteristics" and "Differences in performance" sections, we can infer some performance metrics and their comparison:

CharacteristicAcceptance Criteria (Implied from Predicate/SE Discussion)Reported Device Performance (Subject Device)SE Discussion (Comparison)
Laser Performance
Laser Wavelength500nm to 900nm500nm to 900nmNot applicable (identical)
Max Threshold of Laser Fiber3 Watt3 WattNot applicable (identical)
Transmission of Treatment Laser99.6% (Predicate)99.8%Substantial Equivalent. The difference between predicate and subject device are negligible.
Laser Power Efficiency0.996 (Predicate)0.998Substantial Equivalent. The difference between predicate and subject device are negligible.
Laser Output Power$500 \pm 20%$ mW (Predicate)$500 \pm 15%$ mWSubstantial Equivalent. The Vitreq device has more strict tolerances than the predicate device.
Laser Size (NA value)between 0.1 and 0.2 (Predicate)between 0.1 and 0.2Not applicable. Bench testing is performed (see Tab 18).
Illumination Performance
Light Wavelength425nm to 700nm425nm to 700nmNot applicable (identical)
Transmission of Illumination Light (Illuminated Laser Probes)Unknown (Predicate) / Less than light fibers/chandeliers12.5%Identical, transmission of illuminated laser probes is less than light fibers/chandeliers.
Transmission of Illumination Light (Light Fibers/Chandelier)39% (Predicate)39%Identical.
Light TypeXenon or Mercury (Predicate)LED, Xenon or MercurySubstantial Equivalent. Vitreq also tested the LED, art technology. The values Xenon and LED are substantial equivalent. Bench testing is performed see Tab 18.
Safety/Biocompatibility/Sterilization
Sterilant ResidualsBelow allowable limits (implied)Below allowable limitsSuccessful adoption to validated Ethylene Oxide method.
Bacterial EndotoxinsBelow allowable limits (implied)Below allowable limitsSuccessful adoption to validated Ethylene Oxide method.
Shelf Life5 years after sterilization (implied via study)5 years after sterilizationShelf life study performed to establish expiration date.
BiocompatibilityISO 10993-1 and FDA quidance compliant (implied)Evaluated and tested according to ISO 10993-1 and related FDA guidance.Claimed compliant.
Light Hazard ProtectionAccording to ISO 15004-2 (Predicate) / ANSI Z80.36 (Subject)According to ANSI Z80.36-2016Information to the user is provided according to standard ANSI Z80.36-2016.

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective):

The document does not provide explicit sample sizes for any specific test sets for performance. It mentions "Performance Testing Summary" indicating that the devices "have been tested to meet the product requirements and requirements from (safety) standards," covering "performance testing and human factors testing." However, details on the methodology, sample sizes, and specific data provenance (country, retrospective/prospective) are not provided in this public summary.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience):

This information is not available in the provided document. The document describes a medical device (laser probes and light fibers) for surgical use, not an AI/diagnostic device that typically involves expert ground truth establishment for test sets.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

This information is not applicable or not available in the provided context. Adjudication methods are typically relevant for diagnostic studies where expert disagreement on ground truth occurs. This document focuses on the physical and functional performance of a surgical instrument.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

This information is not applicable as the device described is a physical surgical tool (laser probes and light fibers), not an AI-assisted diagnostic or decision support system that would involve human readers or AI assistance.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:

This information is not applicable as the device is a physical surgical tool, not an algorithm or software-only device.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

For the performance testing mentioned (e.g., laser transmission, power output, light transmission, biocompatibility), the "ground truth" would be established by well-defined engineering specifications, international standards (e.g., ISO, ANSI), and validated testing methodologies against which the device's physical and functional properties are measured. It does not involve expert consensus, pathology, or outcomes data in the way a diagnostic AI device would.

8. The sample size for the training set:

This information is not applicable. The device is a physical medical instrument, not an AI model that requires a training set.

9. How the ground truth for the training set was established:

This information is not applicable as the device is a physical medical instrument, not an AI model.

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services USA seal. To the right of the seal is the FDA logo in blue, with the words "U.S. FOOD & DRUG" stacked on top of the word "ADMINISTRATION".

Vitreq B.V. % Genci Omari, Official Correspondent Beaver-Visitec International, Inc. 500 Totten Pond Rd - 10 CityPoint Waltham, Massachusetts 02451

Re: K182646

Trade/Device Name: Vitreq disposable laser probes, light fibers and Chandelier Regulation Number: 21 CFR 886.4690 Regulation Name: Ophthalmic Photocoagulator Regulatory Class: Class II Product Code: HQB, HQF, MPA Dated: March 18, 2019 Received: March 22, 2019

Dear Denise Kelly:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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

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801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

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

Enclosure

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Indications for Use

510(k) Number (if known) K182646

Device Name

VitreQ Disposable Laser Probes, 90° Directional Laser Probes, 90° Directional Illuminated Laser Probes, Light Fibers and Chandelier.

Indications for Use (Describe)

VitreQ Disposable Laser Probes, 90° Directional Laser Probes and 90° Directional Illuminated Laser Probes are intended for use in vitreoretinal surgery to perform endo-ocular laser photocoagulation treatments at operating wavelengths of 500nm to 900nm.

The 90° Directional Illuminated Laser Probes, Light Fibers and Chandelier are for illumination during ophthalmic surgery and should only be used with the light wavelength range of 425nm to 700mm.

Type of Use (Select one or both, as applicable)
☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C) ☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C)
☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary VitreQ Disposable Laser Probes, Light Fibers and Chandelier

Submitter of 510(k):

Company name:VitreQ B.V.
Registration number:3012037425
AddressSeggelant-Noord 2, 3237 MG Vierpolders, The Netherlands
Phone:+31 181 745090
Fax:+31 181 478583
Correspondent:JanKees Wouts
Email:RA@vitreq.com

Device Name:

Device Trade Name:VitreQ Disposable Laser Probes, 90° Directional Laser Probes and(90°) Directional Illuminated Laser ProbesVitreQ Disposable Light Fibers, Standard Light Fibers, Wide ViewLight Fibers, 45 Degree Shielded Light Fibers and Chandelier.
Regulation Number:21 CFR 886.4390
Regulatory Name:Ophthalmic Photocoagulator
Regulatory Class:II
Product Code:HOF, HQB, MPA

Predicate Devices

Our device is substantially equivalent to the predicate device cited in the table below:

510(k)ApplicantDevice NameProduct CodeClaim
K121187Katalyst Surgical, LLCKatalyst Laser Probes & Illuminated Laser ProbesHQF, HQB, MPAPredicate Device (primary)
K151604Peregrine Surgical Ltd.Peregrine 23 ga and 25 ga Adjustable Chandelier IlluminatorMPAPredicate Device (secondary)

Description

The VitreQ Disposable Laser Probe is an ophthalmic instrument, which is used in posterior segment eye surgery and is appropriate for photocoagulation. The device can be connected to an ophthalmic laser generator, which is not a part of this application.

The VitreQ Disposable Laser Probe is introduced into the posterior segment of the eye through an incision or an ophthalmic entry port, after the vitreous is removed during vitreoretinal surgery.

The Disposable Laser Probe guides the laser energy to the intended surgical site to provide photocoagulation treatment. The laser enerqy intensity or power output is not controlled, altered or significantly reduced by the disposable laser probe. The laser spot size on the target tissue can be varied by altering the distance between the tissue and the probe tip.

To reach the target tissue in the periphery section of the 90° Directional Laser Probe tip can be directed due to bending the metal tip. The angle of the tip in the most directed position is about 90°. An angled laser probe reduces the need of a strong indentation of the eye and is intended to prevent accidently touching the crystal lens.

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The VitreQ Disposable Laser Probes, 90° Directional Laser Probes and (90°) Directional Illuminated Laser Probes are constructed with an optical laser connector, a glass fiber optic covered by a protective sheath and one handle for surgeon manipulation, metal tubing is extending from the handle which penetrates the surgical site. The device is intended for singleuse only.

The VitreQ Disposable Laser Probes can only be used with a medical laser at an operating wavelength range of 500nm to 900nm.

For the VitreQ Disposable Laser Probes, (90°) Directional Illuminated Laser Probe the functionality is combined with illumination. To achieve the illumination of the surgical site, the probe is constructed with an additional plastic fiber, which has a connector to attach the fiber to an ophthalmic light source, which is not a part of this application.

The VitreQ Disposable Light Fibers are constructed with a handle, the plastic illumination fiber, and the connector to attach the fiber to an ophthalmic light source. To match the connection to the ophthalmic light source, there are several reusable light source adaptors available.

The VitreQ (90°) Directional Illuminated Laser Probes, Light Fibers and Chandelier can only be used with the light wavelength range of 425nm to 700nm.

Indications for Use:

VitreQ Disposable Laser Probes, 90° Directional Laser Probes and (90°) Directional Illuminated Laser Probes are intended for use in vitreoretinal surgery to perform endo-ocular laser photocoagulation treatments at operating wavelengths of 500nm to 900nm. The (90°) Directional Illuminated Laser Probes, Light Fibers and Chandelier are for illumination during ophthalmic surgery and should only be used with the light wavelength range of 425nm to 700nm.

Summary of technological characteristics

Comparison of identifications for Use

The indications for use of the VitreQ Disposable Laser Probes, Light Fibers and Chandelier are identical to the indications for use of the predicate devices.

The subject device and primary predicate device are both intended for use in vitreoretinal surgery to perform endo-ocular laser photocoaqulation treatments at operating wavelengths of 500nm to 900nm.

Although the secondary predicate device is only used to support similar technology. Both, the subject device and secondary predicate device, are for illumination during ophthalmic surgery. The subject device is more specification of the wavelengths.

Comparison of device characteristics

The table below shows the substantial equivalence with regards to the characteristics of the subject device and predicate device.

CharacteristicsSubject DevicePredicate Device (primary)Predicate Device (secondary)SE Discussion
Directional Laser ProbesIlluminated Laser ProbesLight Fibers & Chandelier
Laser ProbeNitinolNot applicableNitinolNot applicableNot applicable
Laser Optical FiberGlassNot applicableGlassNot applicableNot applicable
CharacteristicsSubject DevicePredicate Device (primary)Predicate Device (secondary)SE Discussion
Directional Laser ProbesIlluminated Laser ProbesLight Fibers & ChandelierK121187 Laser Probes & Illuminated Laser ProbesK151604 23 ga and 25 ga Adjustable Chandelier Illuminator
Illumination FiberNot applicablePMMA Fluorinated Polymer CladdingPMMA Fluorinated Polymer CladdingPMMA Fluorinated Polymer CladdingNot applicable
HandpieceABSPMMA Fluorinated Polymer Cladding3D-printed NylonAcetalSubstantial Equivalent. Vitreq handpiece is made of ABS, it concerns a part which is not in contact with the patient
Laser JacketThermoplastic rubberNot applicableElastomerNot applicableSubstantial Equivalent. Vitreo jacket is made from thermoplastic rubber, it concerns a part which is not in contact with the patient
Light jacketNot applicableLDPE/EVA/ PVCUnknownPTFESubstantial Equivalent. Vitreo jacket is made from EVA/PVC/LDPE, it concerns a part which is not in contact with the patient
NeedleNot applicableStainless Steel / MP35NNot applicableStainless SteelSubstantial Equivalent. Vitreq needle is made from Stainless Steel/ MP35N, it is biocompatible. See Tab 15.
Laser connectorNickel plated brass Stainless SteelNot applicableNickel plated brass Stainless SteelNot applicableNot applicable
Light connectorNot applicableStainless SteelUnknownAcetal with Stainless SteelSubstantial Equivalent. VitreQ connector is from stainless steel only, it concerns a part which is not in contact with the patient
Laser TypeSolid state diodeNot applicableSolid state diodeNot applicableNot applicable
Laser Wavelength500nm to 900nmNot applicable500nm to 900nmNot applicableNot applicable
Max Threshold of Laser Fiber3 WattNot applicable3 WattNot applicableNot applicable
Transmission of Treatment Laser99.8%Not applicable99.6%Not applicableSubstantial Equivalent. The difference between predicate and subject device are negligible. See Tab 18.
Laser Power Efficiency0.998Not applicable0.996Not applicableSubstantial Equivalent. The difference between predicate and subject device are negligible.
Laser Output Power$500 \pm 15%$ mWNot applicable$500 \pm 20%$ mWNot applicableSubstantial Equivalent. The Vitreq device has mor strict tolerances than the predicate device.
Laser SizeNA value between 0.1 and 0.2Not applicableNA value between 0.1 and 0.2Not applicableNot applicable. Bench testing is performed see Tab 18
Light TypeNot applicableLED, Xenon or MercuryXenon or MercuryXenon or MercurySubstantial Equivalent. Vitreq also tested the LED,
CharacteristicsSubject DevicePredicateDevice(primary)PredicateDevice(secondary)SE Discussion
DirectionalLaser ProbesIlluminatedLaser ProbesLight Fibers &ChandelierK121187Laser Probes &Illuminated LaserProbesK15160423 ga and25 gaAdjustableChandelierIlluminator
art technology. The valuesXenon and LED aresubstantial equivalent.Bench testing is performedsee Tab 18.
WavelengthNotapplicable425nm to 700nm425nm to 700nm425nm to 700nmNot applicable
Transmission ofIllumination LightNotapplicable12.5 %39%Unknown39%Identical, transmission ofilluminated laser probes isless than light fibers/chandeliers

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K182646

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Substantial Equivalence Discussion

The VitreQ Disposable Laser Probes, 90° Directional Laser Probes and (90°) Directional Illuminated Laser Probes are intended for use in vitreoretinal surgery to perform endo-ocular laser photocoagulation treatments at operating wavelengths of 500nm to 900nm. The (90°) Directional Illuminated Laser Probes, Light Fibers and Chandelier are for illumination during ophthalmic surgery and should only be used with the light wavelength range of 425nm to 700nm.

The VitreQ Disposable Laser Probes, Light Fibers and Chandelier make use of the same principle of operation, which is transmission of radiation energy through a fiber based on the principle of total reflection within a multimode fiber (consisting of a core and cladding).

The differences in technological characteristics are accompanied by information that demonstrates that the device is as safe and effective as the predicate device.

Design Differences:

The VitreQ Directional Laser probes have a different tip design same surgical result will be achieved.

The VitreQ light fibers have a different tip design, which decrease the hazard of phototoxicity, which is confirmed by test results according to standard ANSI Z80.36.

There are differences in available product sizes between the subject and predicate device, this is not related to safety and efficacy.

The subject and predicate device have a different handle design. Both solutions are considered equivalent to initiate movement of the tip. There are differences in shape and dimensions, which are considered related to the look and feel of the instrument.

The purpose of the jacket of the laser fiber and the optical fiber is identical. There are small differences in dimensions and material.

The lengths of the subject and predicate device are different, but the length of the device is not related to safety and effectiveness.

Reorientation of the subject and predicate device is based on a different principle. Providing a means to direct the device to the surgical site does not influence the safety and effectiveness but can improve performance and allow bimanual surgery to shorten the surgical intervention.

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Differences in materials

The VitreQ handle, jackets (light and light connector have differences with regards to material, but these items are not a patient contact material.

Differences in performance (related to laser only)

The laser power output value of the VitreQ device and the predicate device are identical. The VitreQ device has more strict tolerances than the predicate device.

Differences in performance (related to illumination only)

VitreQ has tested Light Hazard Protection according to the FDA recognized standard ANSI Z80.36-2016. The predicate device delivers information in the Instructions for Use according the standard ISO 15004-2, which is no longer FDA recognized. Information to the user is provided according to standard ANSI Z80.36-2016.

Substantial Equivalence Conclusion

There are differences with regards to design, handle construction, materials, packaging, shelf life and labeling. These differences do not affect the similarity in principal technology. function and operational characteristics of the devices. As a result, it is determined that the Vitreq Disposable Laser Probes, Light Fibers and Chandelier is substantially equivalent to the predicate device.

Sterilization and shelf life

The Vitrea Disposable Laser Probes, Light Fibers and Chandelier have been successfully adopted to the validated Ethylene Oxide sterilization method. Sterilant residuals and bacterial endotoxins are kept below the allowable limits. A Shelf life study is performed to establish an expiration date of 5 years after sterilization.

Biocompatibilitv

The Vitrea Disposable Laser Probes. Light Fibers and Chandelier have been evaluated and tested for biological safety according to the standard ISO 10993-1 and the related FDA quidance for industry.

Performance Testing Summary

The VitreQ Disposable Laser Probes, Light Fibers and Chandelier have been tested to meet the product requirements and requirements from (safety) standards. Verification covers performance testing and human factors testing.

Conclusion

The VitreQ Disposable Laser Probes, Light Fibers and Chandelier were shown to be substantially equivalent to the predicate devices in intended use and fundamental technology and technological characteristics to the predicate devices.

§ 886.4690 Ophthalmic photocoagulator.

(a)
Identification. An ophthalmic photocoagulator is an AC-powered device intended to use the energy from an extended noncoherent light source to occlude blood vessels of the retina, choroid, or iris.(b)
Classification. Class II.