1/2 March 2023
In September 2014, we reported about the FDA guidance draft on Endotoxin Testing Recommendations for Single-Use Intraocular Ophthalmic Devices. Now, on 17 August, the FDA published the adopted version of that guidance document. The FDA developed this guideline related to the prevention respectively the weakening of future Toxic Anterior Segment Syndrome (TASS) outbreaks. TASS is a sterile inflammatory condition localized in the anterior segment of the eye following intraocular surgery. Former TASS outbreaks have been associated with endotoxin. This guidance provides recommendations for endotoxin limits, especially for devices used inside the eye, including intraocular devices and single-use intraocular ophthalmic surgical instruments, because they can be contaminated with endotoxin as part of the manufacturing, sterilization, or packaging processes.
The recommendations made in this guidance are applicable to devices used within the eye, either as permanent implants or as single-use devices used in intraocular surgery. Endotoxin contamination of reusable manual ophthalmic surgical instruments is outside the scope of this guidance.
The devices covered are:
A. Intraocular Fluids (21 CFR 886.4275, Class III), specifically viscoelastic surgical aid (LZP)
B. Anterior Segment Solid Devices
1. Intraocular lenses (21 CFR 886.3600, Class III), including
2. Capsular tension ring devices (Class III), including
4. Phacofragmentation systems (21 CFR 886.4670, Class II), specifically the accessories of irrigation/aspiration sleeves and tubing (HQC)
More details about the background and the recommendations can be found in the adopted Guidance for Industry and Food and Drug Administration Staff "Endotoxin Testing Recommendations for Single-Use Intraocular Ophthalmic Devices".