You Can’T Always Get What You Want: Trifocal-Like Rings In A Monofocal Iol

To describe a case management of a monofocal IOL implantation in which trifocal-like rings appeared on the optic body following its unfolding within the capsular bag. 

The objective is to assess to investigate the underlying cause and whether such unexpected morphological features affect the final refractive result or the patient's quality of vision .

The case was observed in May 2025 in a secondary-care clinical setting at the Ophthalmology Unit of Serristori General Hospital in Figline Valdarno (Florence), Italy. The surgical procedure and all subsequent follow-up evaluations were conducted at this facility in accordance with the tenets of the Declaration of Helsinki, and informed consent was obtained from the patient.

A 71-year-old patient (born 1954) presented with a symptomatic cataract in the left eye (0.3 with +5.00 D sphere)

The patient underwent uneventful phacoemulsification in May 2025. A preloaded monofocal IOL (Johnson & Johnson, Model GCB00, +24.5 D) was implanted, with a refractive target of -0.13 D.

Immediately following the unfolding of the IOL within the capsular bag, the surgeon observed multiple concentric rings on the optic body mimicking the diffractive zones of a trifocal IOL. Given the stable position of the lens and the absence of immediate surgical complications, the decision was made to proceed without IOL exchange.

Postoperative manifest refraction was +0.25/-0.75 x 115°, yielding an UDVA of 1.0 (20/20). Near vision required a +2.50 D addition. Surprisingly, the patient reported a complete absence of glare, halos, or dysphotopsias. Aberrometric analysis confirmed no significant higher-order aberrations (HOAs) attributable to the rings.

A formal technical inquiry was submitted to the manufacturer. The company’s quality assurance laboratory analyzed the production batch and concluded that the rings were the result of a lathe-cutting error during the manufacturing process. The manufacturer further clarified that since monofocal and premium (multifocal) lenses are produced in distinct facilities, a cross-packaging error was effectively ruled out.

The patient remains stable at long-term follow-up, maintaining high satisfaction and optimal visual performance.

• Manufacturing artifacts in monofocal IOLs may occasionally mimic the geometry of multifocal lenses without necessarily compromising optical performance.

• In the presence of unexpected IOL morphological features, intraoperative stability and the absence of significant optical distortion may justify observation over immediate explantation.

• Formal reporting of IOL defects to manufacturers is essential for post-market surveillance and identifying potential systemic manufacturing errors.