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 CO emissions. Rhegmatogenous retinal detachment (RRD) is a common ophthalmic emergency requiring surgical intervention to prevent blindness. Fluorinated gases (FG) such as SF, CF, and CF 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. CO-equivalent emissions (COEM) 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 COEM. SF contributed 170.10 tons (84.5%), CF 26.84 tons (13.3%), and CF 4.40 tons (2.2%). This represents 18.3 tons of COEM annually, corresponding to 0.000003% of Germany's total COEM and 0.00003% of healthcare sector emissions.

CONCLUSION

This first comprehensive analysis of FG consumption and COEM in ppV for RRD in Germany shows that FG contribute a negligible portion to Germany's and healthcare-related COEM. 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.