K Number
K980400
Device Name
PVRS-PEREGRINE VITREORETINAL SCISSOR MODEL PD505.10
Date Cleared
1998-04-30

(87 days)

Product Code
Regulation Number
886.4150
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
For the Peeling and Vertical Cutting of Preretinal Membranes.
Device Description
The PVRS - Peregrine Vitreoretinal Scissor is vertical cutting, provided sterile and consists of the following: A 6' length of (pneumatical) tubing with a luer connector at the proximal end to fit into a surgical console. A Delrin handpiece with a 20 GA stainless steel shaft and scissor tip at the distal end.
More Information

Not Found

Not Found

No
The device description is purely mechanical and pneumatic, with no mention of software, algorithms, or any components that would suggest AI/ML functionality. The "Not Found" entries for AI/ML mentions, image processing, and performance studies further support this conclusion.

Yes
The device is used for "Peeling and Vertical Cutting of Preretinal Membranes," which is a treatment for a medical condition, indicating a therapeutic purpose.

No
The device is described as a surgical tool for "Peeling and Vertical Cutting of Preretinal Membranes," indicating a therapeutic rather than diagnostic function.

No

The device description clearly outlines physical components like tubing, a handpiece, a stainless steel shaft, and a scissor tip, indicating it is a hardware device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is "For the Peeling and Vertical Cutting of Preretinal Membranes." This describes a surgical procedure performed directly on a patient's tissue within the body.
  • Device Description: The device is a surgical instrument (scissors) used for physical manipulation of tissue.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, or tissue samples) outside the body to provide information about a person's health. This device does not perform any such analysis.

Therefore, the PVRS - Peregrine Vitreoretinal Scissor is a surgical instrument, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

For the Peeling and Vertical Cutting of Preretinal Membranes.

Product codes (comma separated list FDA assigned to the subject device)

86 HAF, 86 HQE

Device Description

The PVRS - Peregrine Vitreoretinal Scissor is vertical cutting, provided sterile and consists of the following: A 6' length of (pneumatical) tubing with a luer connector at the proximal end to fit into a surgical console. A Delrin handpiece with a 20 GA stainless steel shaft and scissor tip at the distal end. (see Appendix B)

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

Not Found

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 886.4150 Vitreous aspiration and cutting instrument.

(a)
Identification. A vitreous aspiration and cutting instrument is an electrically powered device, which may use ultrasound, intended to remove vitreous matter from the vitreous cavity or remove a crystalline lens.(b)
Classification. Class II (special controls). The device, when it is phacofragmentation unit replacement tubing, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 886.9.

0

APR 3 0 1998

January 29, 1998

980400

Premarket Notification [510(k)] Summary

Submitter: Peregrine Surgical Ltd. 4050D Skyron Drive Doylestown, PA 18901 Phone: (215) 348-0456 (215) 348-5526 Fax:

Official Correspondent: Amy Hessenthaler

Trade Name: PVRS - Peregrine Vitreoretinal Scissor

Common Name: Vitreoretinal Scissor

Registration Number: 2529392

Classification: Class II

Class Name: Not Known

Panel: Ophthalmic

Product Code: 86 HAF HQE

Device Description: The PVRS - Peregrine Vitreoretinal Scissor is vertical cutting, provided sterile and consists of the following: A 6' length of (pneumatical) tubing with a luer connector at the proximal end to fit into a surgical console. A Delrin handpiece with a 20 GA stainless steel shaft and scissor tip at the distal end. (see Appendix B)

Statement of indications for use. - For the Peeling and Vertical Cutting of Preretinal Membranes.

1

Substantial Equivalence Comparison

| Peregrine
PVRS - Peregrine Vitreo-
Retina Scissor | Grieshaber
MPC - Membrane Peeler Cutter | Grieshaber
Sutherland Instruments |
|---------------------------------------------------------|-----------------------------------------------|-----------------------------------------------|
| Application for 510(K)
Product #505.10 | Manufactured by Grieshaber
Product #625.12 | Manufactured by Grieshaber
Product #612.25 |
| Posterior Cutting | Posterior Cutting | Posterior Cutting |
| pneumatic driven handpiece | electromagnet driven handpiece | manual driven handpiece |
| vertical cutting action | vertical cutting action | vertical cutting action |
| 20 GA stainless steel shaft | 20 GA stainless steel shaft | 20 GA stainless steel shaft |
| insertion through 1mm incision | insertion through 1mm incision | insertion through 1mm incision |
| equipped with cleaning port | equipped with cleaning port | equipped with cleaning port |
| reusable | reusable | reusable |
| | | |

ﺮ ﺍ

Sterility

යේ දි ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

The Device will be ETO Sterilized.

The method used to validate the sterilization cycle is AAMI Overkill Method

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized graphic of three human profiles facing to the right, stacked one above the other.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

APR 3 0 1998

Mr. Todd Richmond Peregrine Surgical Ltd. 4050D Skyron Drive Doylestown, PA 18901

Re: K980400

Trade Name: PVRS - Peregrine Vitreoretinal Scissor Regulatory Class: II Product Code: 86 HQE Dated: January 29, 1998 Received: February 2, 1998

Dear Mr. Richmond:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). 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 (Premarket Approval), 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 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

3

Page 2 - Mr. Todd Richmond

This letter will allow you to begin marketing your device as described in your 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 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. 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" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours,

A Roerl lorenttal

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

Enclosure

4

STATEMENT OF INDICATIONS FOR USE

510K Number (if known): K980400

Device Name: PVRS - Peregrine Vitreoretinal Scissor

Indications for Use:

For the Peeling and Vertical Cutting of Preretinal Membranes.

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED:

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use

OR

Over-The-Counter Use_

Er Beam

XX

Division of Ophthalm 510(k) Number.