Toxic Posterior Segment Syndrome Induced by Silicone Oil Tamponade after Surgery for Rhegmatogenous Retinal Detachment：A Case Report

Toxic Posterior Segment Syndrome Induced by Silicone Oil Tamponade after Surgery for Rhegmatogenous Retinal Detachment：A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Toxic Posterior Segment Syndrome Induced by Silicone Oil Tamponade after Surgery for Rhegmatogenous Retinal Detachment：A Case Report Yihong Ding, Jing Hou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9496745/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Purpose To report a clinical case of silicone oil-induced toxic posterior segment syndrome (TPSS) after rhegmatogenous retinal detachment (RRD) surgery. Case description A 75-year-old female developed TPSS with retinal hemorrhage and vessel sheathing after 25-G pars plana vitrectomy with silicone oil tamponade for left-eye RRD, had recurrent RRD after silicone oil removal, and achieved complete resolution of inflammation at 1-month follow-up after reoperation with 12% C₃F₈ gas tamponade instead of silicone oil, with laboratory tests confirming silicone oil-induced intense intraocular inflammation. Conclusion Silicone oil can induce early postoperative toxic posterior segment syndrome (TPSS), and 12% C₃F₈ inert gas is a viable alternative tamponade material for such cases. Toxic posterior segment syndrome Silicone oil Rhegmatogenous retinal detachment C₃F₈ inert gas Vitrectomy Figures Figure 1 Figure 2 Introduction Silicone oil, as a long-acting intraocular tamponade material with stable physicochemical properties, is one of the core consumables in vitreoretinal surgery for the treatment of complex rhegmatogenous retinal detachment (RRD).[ 1 , 2 ] Its clinical application has been highly refined with a well-documented favorable safety profile in routine clinical practice.[ 2 , 3 ] However, rare silicone oil-induced complications still occur occasionally, among which toxic posterior segment syndrome (TPSS) represents a challenging and underrecognized entity.[ 4 – 6 ] TPSS is typically accompanied by minimal or mild anterior segment inflammation, with the core features being sterile inflammation of the ocular posterior segment characterized by retinal vasculitis and retinal hemorrhage. [ 7 ] Herein, we report a rare case of silicone oil-induced TPSS after RRD surgery. More notably, the patient developed recurrent retinal detachment, and was successfully treated with 12% C₃F₈ inert gas tamponade instead of silicone oil, which provides a valuable clinical reference for the management of similar cases. Case presentation A 75-year-old female presented to our clinic with decreased visual acuity in her left eye for 2 months. She had a medical history of systemic sclerosis diagnosed 35 years prior and pulmonary fibrosis diagnosed 15 years ago, and she was on oral acetylcysteine for maintenance treatment. On examination, the best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/200 in the left eye. Slit-lamp examination showed grade 2 senile cataracts in both eyes. Fundus examination revealed a supranasal retinal degenerative area with a round retinal break within the degenerative region, accompanied by extensive inferior retinal detachment in the left eye. The patient underwent a standard 25-G pars plana vitrectomy for the left eye. During the operation, silicone oil (RT SIL-OL 5000, Zeiss, Berlin, Germany) was used for intraocular tamponade. In addition, other routine auxiliary materials were administered intraoperatively, including triamcinolone acetonide (TA) and perfluorocarbon liquids (PFCL). Intraoperative perfusion pressure was maintained at 22 mmHg, and at the end of the surgery, the intraocular pressure was adjusted to approximately 17 mmHg, which was measured by a Schiotz tonometer (Riester, Germany). On postoperative day 1, the patient’s visual acuity was 20/100, intraocular pressure was 16 mmHg, the retina was well-attached, and laser photocoagulation spots were visible around the retinal break and degenerative area. On postoperative day 2, visual acuity remained 20/100, and no significant anterior segment inflammation was observed. However, fundus examination revealed extensive patchy retinal hemorrhage with central fibrinous exudation and localized retinal vessel sheathing ( Fig. 1 a ) . And fluorescein fundus angiography (FFA) showed capillary dilation and staining ( Fig. 1 b ) . A preliminary diagnosis of TPSS was made, and the patient received a peribulbar injection of TA 40 mg. On postoperative day 10, the patient’s visual acuity remained 20/100. Fundus examination showed that the retinal hemorrhage had partially absorbed compared with the previous examination, and the sheathing of retinal vessels had basically subsided ( Fig. 1 c ) . However, to avoid the persistent risk induced by silicone oil after the effect of TA faded, the patient underwent silicone oil removal combined with cataract surgery on the 14th postoperative day. After this operation, the patient’s visual acuity recovered to 20/33. (b) Fluorescein fundus angiography (FFA) of the left eye on postoperative day 2, showing abnormal capillary dilation, fluorescein staining of vessel walls (arrow), and fluorescence masking in the areas of retinal hemorrhage (*). (c)Fundus photograph of the left eye on postoperative day 10. Compared with Fig. 2 (a), the intraretinal hemorrhage (*) and retinal vessel sheathing (arrow) are partially absorbed. Nevertheless, 5 days after silicone oil removal, the patient complained of decreased visual acuity again. Fundus examination revealed recurrent retinal detachment in the left eye. The patient underwent 25-G pars plana vitrectomy again, with TA and PFCL used as auxiliary materials. However, 12% C₃F₈ was selected as the intraocular tamponade instead of silicone oil this time, and the patient maintained a prone position after the operation. No retinal hemorrhage or retinal vessel sheathing was observed in the patient after this operation. At the 1-month follow-up, complete absorption of retinal hemorrhage was noted, and the patient’s visual acuity recovered to 20/25 ( Fig. 2 ) . Discussion In this case, we observed the occurrence of extensive intraretinal hemorrhage and retinal vessel sheathing at the early stage after silicone oil tamponade surgery. This clinical manifestation is consistent with the characteristics of toxic posterior segment syndrome (TPSS) reported in previous literature. For instance, Sriram et al. reported a case of early postoperative retinal vasculitis[ 5 ]; Niroj et al. described three cases of occlusive retinal vasculitis[ 4 ]; and Miho et al. documented a case of early retinal vascular occlusion as manifestations of silicone oil-induced TPSS.[ 6 ]And a well-recognized potential cause of silicone oil-induced TPSS is the inherent impurities in silicone oil, including linear and cyclic low-molecular-weight components (LMWCs), which are known to induce ocular toxic reactions and trigger inflammatory responses in the ocular posterior segment.[ 8 – 10 ] Based on the typical clinical features and relevant literature evidence, we made a preliminary diagnosis of TPSS in this patient. Meanwhile, we collected the patient’s aqueous humor and peripheral blood for laboratory testing, and the results revealed immunological abnormalities. Specifically, the level of interleukin-6 (IL-6) in the aqueous humor was markedly elevated to 118.85 pg/mL (reference range: 0–11.09 pg/mL); the proportion of highly suppressive regulatory T (Treg) cells in the blood increased abnormally to 48.4% (reference range: 2.6–29.1%); and the peripheral blood levels of tumor necrosis factor-alpha (TNF-α) and interleukin-2 (IL-2) were also elevated. IL-6 and TNF-α are key pro-inflammatory cytokines that play crucial roles in mediating acute inflammatory responses, promoting vascular endothelial damage, and inducing inflammatory cell infiltration[ 11 , 12 ]; IL-2 is involved in regulating T cell activation and proliferation[ 13 ], while highly suppressive Treg cells function to maintain immune homeostasis and inhibit excessive inflammatory reactions.[ 14 ] These abnormal immunological indicators, combined with the patient’s long-standing history of systemic sclerosis and pulmonary fibrosis—both of which are immune-mediated systemic diseases—suggest that the patient was in a state of systemic immune dysregulation. This existing immune disorder background may have rendered the patient more susceptible to ocular inflammatory reactions induced by silicone oil, thus serving as a contributing factor to the development of TPSS. Furthermore, TPSS has been reported to be induced by various intraoperative factors, including different intraocular materials (e.g., perfluorocarbon liquids) and even contaminated surgical instruments.[ 7 , 15 ] However, in this case, the patient underwent two separate 25-G pars plana vitrectomy procedures due to recurrent retinal detachment, and the surgical instruments and all auxiliary materials used in the two operations were completely consistent, including PFCL and TA. The only critical difference between the two surgeries was the intraocular tamponade material: silicone oil was used in the first surgery, while 12% C₃F₈ inert gas was adopted as the alternative in the second surgery. Notably, TPSS occurred only after the first surgery, and no similar inflammatory manifestations were observed after the second surgery with C₃F₈ gas tamponade. This clear comparison confirms that silicone oil was the primary inducer of TPSS in this case, and also suggests that 12% C₃F₈ inert gas may be a feasible alternative tamponade material for patients of silicone oil-induced TPSS. In summary, two key clinical inferences can be drawn from this case. First, when extensive retinal hemorrhage and retinal vascular inflammatory changes occur in the early postoperative period after silicone oil tamponade, especially in patients with pre-existing systemic immune dysregulation, TPSS should be highly suspected as a potential diagnosis. Second, for patients diagnosed with silicone oil-induced TPSS, early silicone oil removal combined with the use of 12% C₃F₈ inert gas as an alternative intraocular tamponade material may be a clinically effective management strategy. Declarations Competing interests The authors declare no competing interests. Funding Technological Innovation and Cultivation Fund for Medical Youth of Peking University (BMU2020PYB014). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Author contributions Y.H.D-collecting the patient data, writing the manuscript; H.J- performing the clinical management of the patient, interpreting the findings, and revising the manuscript. All authors commented on and approved the manuscript. Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent was obtained from the patient for publication of this case report and the accompanying clinical images. All identifying information has been removed. Data availability No datasets were generated or analyzed during the current study. References Chen Y, Kearns VR, Zhou L, Sandinha T, Lam WC, Steel DH, Chan YK. Silicone oil in vitreoretinal surgery: indications, complications, new developments and alternative long-term tamponade agents. Acta Ophthalmol. 2021;99(3):240–50. Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology. 1988;95(7):870–6. Pichi F, Hay S, Abboud EB. Inner retinal toxicity due to silicone oil: a case series and review of the literature. Int Ophthalmol. 2020;40(9):2413–22. Sahoo NK, Behera S, Narayanan R, Chhablani J. Toxic Posterior Segment Syndrome Presenting as Occlusive Retinal Vasculitis following Vitreoretinal Surgery. J Curr Ophthalmol. 2021;33(3):345–8. Simakurthy S, Kumar M, Jain H, Kanakamedala A, Gudimetla J. Silicone oil tamponade induced vasculitis- a rare manifestation of toxic posterior segment syndrome. Eur J Ophthalmol. 2024;34(2):Np118–20. Kumoi M, Matsuda S, Matsumoto M, Tsujino C, Otori Y. Toxic posterior segment syndrome caused by silicone oil tamponade resulting in postsurgical retinal vascular occlusion: a case report. Am J Ophthalmol Case Rep. 2025;39:102404. Amigó A, Martinez-Sorribes P. Toxic Intraocular Syndrome. J Ophthalmic Vis Res. 2022;17(1):155–6. Nakamura K, Refojo MF, Crabtree DV, Leong FL. Analysis and fractionation of silicone and fluorosilicone oils for intraocular use. Investig Ophthalmol Vis Sci. 1990;31(10):2059–69. Nakamura K, Refojo MF, Crabtree DV, Pastor J, Leong FL. Ocular toxicity of low-molecular-weight components of silicone and fluorosilicone oils. Investig Ophthalmol Vis Sci. 1991;32(12):3007–20. Morescalchi F, Costagliola C, Duse S, Gambicorti E, Parolini B, Arcidiacono B, Romano MR, Semeraro F. Heavy silicone oil and intraocular inflammation. Biomed Res Int. 2014;2014:574825. Dick AD, Forrester JV, Liversidge J, Cope AP. The role of tumour necrosis factor (TNF-alpha) in experimental autoimmune uveoretinitis (EAU). Prog Retin Eye Res. 2004;23(6):617–37. Yu X, Duan R, Jiang L, Wang T, Li Z, Zhang B, Su W, Lin Y. Interleukin-6 in non-infectious uveitis: Biology, experimentalevidence and treatment strategies. Biochem Pharmacol. 2024;230(Pt 2):116605. Antony PA, Paulos CM, Ahmadzadeh M, Akpinarli A, Palmer DC, Sato N, Kaiser A, Hinrichs CS, Klebanoff CA, Tagaya Y, et al. Interleukin-2-dependent mechanisms of tolerance and immunity in vivo. J Immunol. 2006;176(9):5255–66. Alroqi FJ, Chatila TA. T Regulatory Cell Biology in Health and Disease. Curr Allergy Asthma Rep. 2016;16(4):27. Jayadev C, Gupta A, Gadde SG, Venkatesh R. Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report. BMC Ophthalmol. 2023;23(1):464. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 May, 2026 Reviewers agreed at journal 08 May, 2026 Reviewers agreed at journal 08 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers invited by journal 01 May, 2026 Editor assigned by journal 01 May, 2026 Editor invited by journal 27 Apr, 2026 Submission checks completed at journal 25 Apr, 2026 First submitted to journal 25 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9496745","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":637142733,"identity":"d51c29e2-9777-42e1-a198-c1e86a82edfc","order_by":0,"name":"Yihong Ding","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yihong","middleName":"","lastName":"Ding","suffix":""},{"id":637142734,"identity":"3745b29d-2235-4d32-b99d-84ebc2733fe9","order_by":1,"name":"Jing Hou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCAzxAgkeCgYG9sfHhB9K08BxuNpYgXgsISKS3CfDgVQoFfLfPHnzMI2ORJx/5sI1BgsFOTreBgBbJc3nJxjw8EsWGtxPbHhQwJBubHSCgxeAMj5k0UEvixtmJ7QYSDAcStxGvZebBNgkekrTMl2AkUovkGR5jwzlALRt4EoGBbECEX/jO8Bg+eNtTlzi//fjDhx8q7OQIagEDxh6gC8EqDYhRDgY/GBjkG4hWPQpGwSgYBSMNAABfpT75KXjVOwAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"Hou","suffix":""}],"badges":[],"createdAt":"2026-04-22 13:08:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9496745/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9496745/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109118241,"identity":"a8ac8e8f-47da-4e58-9dc0-c30a72b6c1f6","added_by":"auto","created_at":"2026-05-12 16:51:35","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1121455,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e(a) Fundus photograph of the left eye on postoperative day 2. The retina is well-attached, and extensive intraretinal patchy hemorrhage with central fibrinous exudation (*) and localized sheathing of retinal vessels (arrow) are clearly visible.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(b) Fluorescein fundus angiography (FFA) of the left eye on postoperative day 2, showing abnormal capillary dilation, fluorescein staining of vessel walls (arrow), and fluorescence masking in the areas of retinal hemorrhage (*).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(c)Fundus photograph of the left eye on postoperative day 10. Compared with Figure2(a), the intraretinal hemorrhage (*) and retinal vessel sheathing (arrow) are partially absorbed.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9496745/v1/953969fc5d54cf94e55d3f2b.jpeg"},{"id":109118242,"identity":"e7ba63eb-67a0-4222-936d-2796f8f07a58","added_by":"auto","created_at":"2026-05-12 16:51:35","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":197262,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFundus photograph of the left eye 1 month after the second vitrectomy with 12% C₃F₈ gas tamponade for recurrent retinal detachment. The retina is well-attached, a small amount of residual gas is visible in the superior fundus, and the intraretinal hemorrhage and retinal vessel sheathing have been absorbed.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9496745/v1/21cf242c8dd817647380257a.jpeg"},{"id":109204995,"identity":"769690d6-715d-4294-af64-28978e849583","added_by":"auto","created_at":"2026-05-13 15:03:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1441874,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9496745/v1/12659344-847d-45f5-b9a9-43b73164bb0a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Toxic Posterior Segment Syndrome Induced by Silicone Oil Tamponade after Surgery for Rhegmatogenous Retinal Detachment：A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSilicone oil, as a long-acting intraocular tamponade material with stable physicochemical properties, is one of the core consumables in vitreoretinal surgery for the treatment of complex rhegmatogenous retinal detachment (RRD).[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Its clinical application has been highly refined with a well-documented favorable safety profile in routine clinical practice.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] However, rare silicone oil-induced complications still occur occasionally, among which toxic posterior segment syndrome (TPSS) represents a challenging and underrecognized entity.[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] TPSS is typically accompanied by minimal or mild anterior segment inflammation, with the core features being sterile inflammation of the ocular posterior segment characterized by retinal vasculitis and retinal hemorrhage. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHerein, we report a rare case of silicone oil-induced TPSS after RRD surgery. More notably, the patient developed recurrent retinal detachment, and was successfully treated with 12% C₃F₈ inert gas tamponade instead of silicone oil, which provides a valuable clinical reference for the management of similar cases.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 75-year-old female presented to our clinic with decreased visual acuity in her left eye for 2 months. She had a medical history of systemic sclerosis diagnosed 35 years prior and pulmonary fibrosis diagnosed 15 years ago, and she was on oral acetylcysteine for maintenance treatment. On examination, the best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/200 in the left eye. Slit-lamp examination showed grade 2 senile cataracts in both eyes. Fundus examination revealed a supranasal retinal degenerative area with a round retinal break within the degenerative region, accompanied by extensive inferior retinal detachment in the left eye.\u003c/p\u003e \u003cp\u003eThe patient underwent a standard 25-G pars plana vitrectomy for the left eye. During the operation, silicone oil (RT SIL-OL 5000, Zeiss, Berlin, Germany) was used for intraocular tamponade. In addition, other routine auxiliary materials were administered intraoperatively, including triamcinolone acetonide (TA) and perfluorocarbon liquids (PFCL). Intraoperative perfusion pressure was maintained at 22 mmHg, and at the end of the surgery, the intraocular pressure was adjusted to approximately 17 mmHg, which was measured by a Schiotz tonometer (Riester, Germany).\u003c/p\u003e \u003cp\u003eOn postoperative day 1, the patient\u0026rsquo;s visual acuity was 20/100, intraocular pressure was 16 mmHg, the retina was well-attached, and laser photocoagulation spots were visible around the retinal break and degenerative area. On postoperative day 2, visual acuity remained 20/100, and no significant anterior segment inflammation was observed. However, fundus examination revealed extensive patchy retinal hemorrhage with central fibrinous exudation and localized retinal vessel sheathing \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea\u003cb\u003e)\u003c/b\u003e. And fluorescein fundus angiography (FFA) showed capillary dilation and staining \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb\u003cb\u003e)\u003c/b\u003e. A preliminary diagnosis of TPSS was made, and the patient received a peribulbar injection of TA 40 mg.\u003c/p\u003e \u003cp\u003eOn postoperative day 10, the patient\u0026rsquo;s visual acuity remained 20/100. Fundus examination showed that the retinal hemorrhage had partially absorbed compared with the previous examination, and the sheathing of retinal vessels had basically subsided \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec\u003cb\u003e)\u003c/b\u003e. However, to avoid the persistent risk induced by silicone oil after the effect of TA faded, the patient underwent silicone oil removal combined with cataract surgery on the 14th postoperative day. After this operation, the patient\u0026rsquo;s visual acuity recovered to 20/33.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e(b) Fluorescein fundus angiography (FFA) of the left eye on postoperative day 2, showing abnormal capillary dilation, fluorescein staining of vessel walls (arrow), and fluorescence masking in the areas of retinal hemorrhage (*).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e(c)Fundus photograph of the left eye on postoperative day 10. Compared with\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e(a), the intraretinal hemorrhage (*) and retinal vessel sheathing (arrow) are partially absorbed.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNevertheless, 5 days after silicone oil removal, the patient complained of decreased visual acuity again. Fundus examination revealed recurrent retinal detachment in the left eye. The patient underwent 25-G pars plana vitrectomy again, with TA and PFCL used as auxiliary materials. However, 12% C₃F₈ was selected as the intraocular tamponade instead of silicone oil this time, and the patient maintained a prone position after the operation. No retinal hemorrhage or retinal vessel sheathing was observed in the patient after this operation. At the 1-month follow-up, complete absorption of retinal hemorrhage was noted, and the patient\u0026rsquo;s visual acuity recovered to 20/25 \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this case, we observed the occurrence of extensive intraretinal hemorrhage and retinal vessel sheathing at the early stage after silicone oil tamponade surgery. This clinical manifestation is consistent with the characteristics of toxic posterior segment syndrome (TPSS) reported in previous literature. For instance, Sriram et al. reported a case of early postoperative retinal vasculitis[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; Niroj et al. described three cases of occlusive retinal vasculitis[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; and Miho et al. documented a case of early retinal vascular occlusion as manifestations of silicone oil-induced TPSS.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]And a well-recognized potential cause of silicone oil-induced TPSS is the inherent impurities in silicone oil, including linear and cyclic low-molecular-weight components (LMWCs), which are known to induce ocular toxic reactions and trigger inflammatory responses in the ocular posterior segment.[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Based on the typical clinical features and relevant literature evidence, we made a preliminary diagnosis of TPSS in this patient.\u003c/p\u003e \u003cp\u003eMeanwhile, we collected the patient\u0026rsquo;s aqueous humor and peripheral blood for laboratory testing, and the results revealed immunological abnormalities. Specifically, the level of interleukin-6 (IL-6) in the aqueous humor was markedly elevated to 118.85 pg/mL (reference range: 0\u0026ndash;11.09 pg/mL); the proportion of highly suppressive regulatory T (Treg) cells in the blood increased abnormally to 48.4% (reference range: 2.6\u0026ndash;29.1%); and the peripheral blood levels of tumor necrosis factor-alpha (TNF-α) and interleukin-2 (IL-2) were also elevated. IL-6 and TNF-α are key pro-inflammatory cytokines that play crucial roles in mediating acute inflammatory responses, promoting vascular endothelial damage, and inducing inflammatory cell infiltration[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; IL-2 is involved in regulating T cell activation and proliferation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], while highly suppressive Treg cells function to maintain immune homeostasis and inhibit excessive inflammatory reactions.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] These abnormal immunological indicators, combined with the patient\u0026rsquo;s long-standing history of systemic sclerosis and pulmonary fibrosis\u0026mdash;both of which are immune-mediated systemic diseases\u0026mdash;suggest that the patient was in a state of systemic immune dysregulation. This existing immune disorder background may have rendered the patient more susceptible to ocular inflammatory reactions induced by silicone oil, thus serving as a contributing factor to the development of TPSS.\u003c/p\u003e \u003cp\u003eFurthermore, TPSS has been reported to be induced by various intraoperative factors, including different intraocular materials (e.g., perfluorocarbon liquids) and even contaminated surgical instruments.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] However, in this case, the patient underwent two separate 25-G pars plana vitrectomy procedures due to recurrent retinal detachment, and the surgical instruments and all auxiliary materials used in the two operations were completely consistent, including PFCL and TA. The only critical difference between the two surgeries was the intraocular tamponade material: silicone oil was used in the first surgery, while 12% C₃F₈ inert gas was adopted as the alternative in the second surgery. Notably, TPSS occurred only after the first surgery, and no similar inflammatory manifestations were observed after the second surgery with C₃F₈ gas tamponade. This clear comparison confirms that silicone oil was the primary inducer of TPSS in this case, and also suggests that 12% C₃F₈ inert gas may be a feasible alternative tamponade material for patients of silicone oil-induced TPSS.\u003c/p\u003e \u003cp\u003eIn summary, two key clinical inferences can be drawn from this case. First, when extensive retinal hemorrhage and retinal vascular inflammatory changes occur in the early postoperative period after silicone oil tamponade, especially in patients with pre-existing systemic immune dysregulation, TPSS should be highly suspected as a potential diagnosis. Second, for patients diagnosed with silicone oil-induced TPSS, early silicone oil removal combined with the use of 12% C₃F₈ inert gas as an alternative intraocular tamponade material may be a clinically effective management strategy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTechnological\u0026nbsp;Innovation\u0026nbsp;and\u0026nbsp;Cultivation\u0026nbsp;Fund\u0026nbsp;for\u0026nbsp;Medical\u0026nbsp;Youth\u0026nbsp;of\u0026nbsp;Peking\u0026nbsp;University\u0026nbsp;(BMU2020PYB014). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.H.D-collecting the patient data, writing the manuscript;\u0026nbsp;H.J-\u0026nbsp;performing the clinical management of the patient, interpreting the findings, and revising the manuscript. All authors commented on and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and the accompanying clinical images. All identifying information has been removed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen Y, Kearns VR, Zhou L, Sandinha T, Lam WC, Steel DH, Chan YK. Silicone oil in vitreoretinal surgery: indications, complications, new developments and alternative long-term tamponade agents. Acta Ophthalmol. 2021;99(3):240\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFederman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology. 1988;95(7):870\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePichi F, Hay S, Abboud EB. Inner retinal toxicity due to silicone oil: a case series and review of the literature. Int Ophthalmol. 2020;40(9):2413\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahoo NK, Behera S, Narayanan R, Chhablani J. Toxic Posterior Segment Syndrome Presenting as Occlusive Retinal Vasculitis following Vitreoretinal Surgery. J Curr Ophthalmol. 2021;33(3):345\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimakurthy S, Kumar M, Jain H, Kanakamedala A, Gudimetla J. Silicone oil tamponade induced vasculitis- a rare manifestation of toxic posterior segment syndrome. Eur J Ophthalmol. 2024;34(2):Np118\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumoi M, Matsuda S, Matsumoto M, Tsujino C, Otori Y. Toxic posterior segment syndrome caused by silicone oil tamponade resulting in postsurgical retinal vascular occlusion: a case report. Am J Ophthalmol Case Rep. 2025;39:102404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmig\u0026oacute; A, Martinez-Sorribes P. Toxic Intraocular Syndrome. J Ophthalmic Vis Res. 2022;17(1):155\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura K, Refojo MF, Crabtree DV, Leong FL. Analysis and fractionation of silicone and fluorosilicone oils for intraocular use. Investig Ophthalmol Vis Sci. 1990;31(10):2059\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura K, Refojo MF, Crabtree DV, Pastor J, Leong FL. Ocular toxicity of low-molecular-weight components of silicone and fluorosilicone oils. Investig Ophthalmol Vis Sci. 1991;32(12):3007\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorescalchi F, Costagliola C, Duse S, Gambicorti E, Parolini B, Arcidiacono B, Romano MR, Semeraro F. Heavy silicone oil and intraocular inflammation. Biomed Res Int. 2014;2014:574825.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDick AD, Forrester JV, Liversidge J, Cope AP. The role of tumour necrosis factor (TNF-alpha) in experimental autoimmune uveoretinitis (EAU). Prog Retin Eye Res. 2004;23(6):617\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu X, Duan R, Jiang L, Wang T, Li Z, Zhang B, Su W, Lin Y. Interleukin-6 in non-infectious uveitis: Biology, experimentalevidence and treatment strategies. Biochem Pharmacol. 2024;230(Pt 2):116605.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntony PA, Paulos CM, Ahmadzadeh M, Akpinarli A, Palmer DC, Sato N, Kaiser A, Hinrichs CS, Klebanoff CA, Tagaya Y, et al. Interleukin-2-dependent mechanisms of tolerance and immunity in vivo. J Immunol. 2006;176(9):5255\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlroqi FJ, Chatila TA. T Regulatory Cell Biology in Health and Disease. Curr Allergy Asthma Rep. 2016;16(4):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayadev C, Gupta A, Gadde SG, Venkatesh R. Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report. BMC Ophthalmol. 2023;23(1):464.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Toxic posterior segment syndrome, Silicone oil, Rhegmatogenous retinal detachment, C₃F₈ inert gas, Vitrectomy","lastPublishedDoi":"10.21203/rs.3.rs-9496745/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9496745/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose\u003c/p\u003e\n\u003cp\u003eTo report a clinical case of silicone oil-induced toxic posterior segment syndrome (TPSS) after rhegmatogenous retinal detachment (RRD) surgery.\u003c/p\u003e\n\u003cp\u003eCase description\u003c/p\u003e\n\u003cp\u003eA 75-year-old female developed TPSS with retinal hemorrhage and vessel sheathing after 25-G pars plana vitrectomy with silicone oil tamponade for left-eye RRD, had recurrent RRD after silicone oil removal, and achieved complete resolution of inflammation at 1-month follow-up after reoperation with 12% C₃F₈ gas tamponade instead of silicone oil, with laboratory tests confirming silicone oil-induced intense intraocular inflammation.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eSilicone oil can induce early postoperative toxic posterior segment syndrome (TPSS), and 12% C₃F₈ inert gas is a viable alternative tamponade material for such cases.\u003c/p\u003e","manuscriptTitle":"Toxic Posterior Segment Syndrome Induced by Silicone Oil Tamponade after Surgery for Rhegmatogenous Retinal Detachment：A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 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