[Sulphur hexafluoride (SF6) and climate impact: is the medical use still justified?].

BACKGROUND

Sulphur hexafluoride (SF6) is commonly used in surgical treatment of retinal detachment and macular holes as well as in Descemet membrane endothelial keratoplasty (DMEK). At the same time, SF6 is by far the most climate-damaging greenhouse gas known, with a global warming potential 24,300 times higher than carbon dioxide (CO2).

OBJECTIVE

Assessment of the climate impact of the ophthalmological surgical use of SF6.

MATERIAL AND

METHODS

Systematic literature search.

RESULTS

The CO2 equivalent of the amount of SF6 consumed during a vitrectomy corresponds to driving 9 km by car with a combustion engine. Replacing SF6 with other endotamponades can be associated with medical disadvantages. For example, the likewise climate-damaging gases hexafluoroethane (C2F6) and octafluoropropane (C3F8) result in prolonged visual rehabilitation, silicone oil in the need for a second surgery, and air in a possibly poorer efficacy depending on the indications. The use of SF6 should be reduced as far as medically possible, e.g. by avoiding unused excess gas during surgery. Additional changes with significant climate-protective effect include reducing or recycling operation room waste, switching from anesthetic gas to intravenous or local anesthesia, and reducing follow-up visits.

CONCLUSION

Medical practices need to be reviewed regularly for their impact on climate change and adapted if necessary. This should, however, not result in medical disadvantages for the patient. Randomized clinical trials appear vital to assess whether greenhouse gases as tamponades can be replaced by air for specific forms of ophthalmological surgery.