Borgia Alfredo, Airaldi Matteo, Kaye Stephen, Romano Vito, Dell'Omo Roberto, Gadhvi Kunal, Moussa George, Raimondi Raffaele
St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
Cornea. 2024 Oct 2. doi: 10.1097/ICO.0000000000003707.
The purpose of this study was to examine the direct impact on carbon emissions attributed to the use of fluorinated gases in endothelial keratoplasty (EK) procedures using gas tamponade and to evaluate the respective carbon footprint of different gas delivery systems used in EK procedures.
In this retrospective, single-center environmental impact study, all corneal procedures using fluorinated gases between January 2021 and January 2024 at the Royal Liverpool University Hospital were reviewed and included. The CO2 equivalent emissions were calculated based on the mass of each fluorinated gas used, following the guidelines of the Intergovernmental Panel on Climate Change.
Of 357 total procedures (160 Descemet membrane endothelial keratoplasty [44.8%], 118 Descemet stripping automated endothelial keratoplasty [33.1%], and 79 rebubbling [22.1%]), single-use sulfur hexafluoride (SF6) canisters were used in 278 (77.9%) procedures. SF6 canisters used in corneal transplantation emitted nearly 1.5 tons of CO2 over 3 years. The 30-mL canisters emitted twice the CO2 per GBP compared to SF6 15-mL canisters and 4 times that of C2F6 or C3F8 15-mL canisters.
Fluorinated gas use in corneal transplantation has a significant environmental impact, which can be reduced by the use of smaller single-use canisters with lower carbon footprint, although manufacturing and disposal concerns remain. Our findings advocate for a more environmentally conscious approach to EK, favoring the use of smaller, more cost-efficient canisters and considering air as an alternative tamponade where possible.
本研究旨在探讨气体填充式内皮角膜移植术（EK）中使用氟化气体对碳排放的直接影响，并评估EK手术中使用的不同气体输送系统各自的碳足迹。
在这项回顾性单中心环境影响研究中，对2021年1月至2024年1月在皇家利物浦大学医院进行的所有使用氟化气体的角膜手术进行了回顾并纳入研究。根据政府间气候变化专门委员会的指导方针，基于每种使用的氟化气体的质量计算二氧化碳当量排放量。
在总共357例手术中（160例Descemet膜内皮角膜移植术[44.8%]，118例Descemet剥脱自动内皮角膜移植术[33.1%]，79例再注气[22.1%]），278例（77.9%）手术使用了一次性六氟化硫（SF6）罐。角膜移植中使用的SF6罐在3年内排放了近1.5吨二氧化碳。与15毫升SF6罐相比，30毫升罐每英镑排放的二氧化碳是其两倍，是15毫升C2F6或C3F8罐的4倍。
角膜移植中使用氟化气体对环境有重大影响，使用碳足迹较低的较小一次性罐可减少这种影响，尽管仍存在制造和处置方面的问题。我们的研究结果提倡对EK采取更具环境意识的方法，倾向于使用更小、更具成本效益的罐，并在可能的情况下考虑使用空气作为替代填充气体。
