Carbon footprint of Pars plana vitrectomies in rhegmatogenous retinal detachment in Germany between 2013 and 2023 - A cohort study of fluorinated gas emissions.

PURPOSE: Climate change, largely driven by greenhouse gas emissions, is a global threat. The healthcare sector contributes significantly - 4.4% of global and 5.2% of Germany's CO2 emissions. Rhegmatogenous retinal detachment (RRD) is a common ophthalmic emergency requiring surgical intervention to prevent blindness. Fluorinated gases (FG) such as SF6, C2F6, and C3F8 are routinely used in pars plana vitrectomy (ppV) due to their expansive properties, but they have a strong greenhouse effect. With an European Union-wide ban under consideration, this study assesses the associated emissions from ppV for RRD in Germany.

METHODS

We analyzed DRG-coded ppV data for RRD (2013-2023) from the German Federal Statistical Office. A national survey of vitreoretinal surgeons provided information on endotamponade preferences. CO2-equivalent emissions (CO2EM) were calculated using GWP100 values from the IPCC report.

RESULTS

Between 2013 and 2023, 354,505 ppV for RDD were performed in Germany. Gas tamponade was used in 55.3% of cases, silicone oil in 27.7%, and air in 16.9%. FG resulted in 201.34 tons of CO2EM. SF6 contributed 170.10 tons (84.5%), C2F6 26.84 tons (13.3%), and C3F8 4.40 tons (2.2%). This represents 18.3 tons of CO2EM annually, corresponding to 0.000003% of Germany's total CO2EM and 0.00003% of healthcare sector emissions.

CONCLUSION

This first comprehensive analysis of FG consumption and CO2EM in ppV for RRD in Germany shows that FG contribute a negligible portion to Germany's and healthcare-related CO2EM. Gas tamponade remains crucial for the treatment of RDD and should therefore not be banned until proven alternatives exist. Further studies are needed to explore alternatives.