Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: A multicentre study of 3,239 patients

Abstract

Purpose To report the potential reduction of carbon emissions by utilising air-tamponade (AT), where possible, instead of fluorinated gases in the management of rhegmatogenous retinal detachment (RRD). We compared the carbon CO2 emissions produced at two large tertiary referral vitreoretinal (VR) centres where RRD are exclusively repaired using fluorinated gases to a tertiary VR mass of each gas used according to the Intergovernmental Panel on Climate Change. Materials and methods Retrospective, continuous, comparative multicentre study of all procedures using fluorinated gases between 01/01/17-31/12/20 at the Manchester Royal Eye Hospital (MREH) and Birmingham and Midland Eye Centre (BMEC), and between 01/01/19-31/12/2020 at the University Hospitals Coventry and Warwickshire (UHCW). Results We report on 3,239 (SF6:1,415 [43.7%], C2F6:1,235 [38.1%], C3F8:541 [16.7%], Air:48 [1.5%]) procedures. UHCW and BMEC utilise single use 30ml and 75ml cannisters, respectively and MREH use multi-use gas cylinders. UHCW used AT in 48 (70%) of RRD repairs. Mean equivalent mass CO2/patient was MREH:115.9kg, BMEC:7.9kg and UHCW:1.9kg. If assuming all centres used 30ml cannisters, the mean equivalent mass CO2/patient was MREH:3.5 kg, BMEC:3.1kg and UHCW:1.9kg. AT enabled UHCW to greatly reduce the need for the most environmentally damaging SF6 gas, leading to lower CO2 emissions by 47.0% and 41.1% compared to MREH and BMEC, respectively. Conclusion We demonstrate how AT vs. the fluorinated gases can reduce in carbon footprint in the management of RRD. Further studies are required to determine the most ‘environment-friendly’ intraocular tamponade without compromising patient outcomes centre that also routinely employs AT in selected RRD cases.

Interventions for sustainable surgery: a systematic review

“…These included a multicentered trial comparing the environmental impact of using air tamponade versus fluorinated gases in repairing selected rhegmatogenous retinal detachment (RRD). When using air tamponade in 70% of RRD repairs, one hospital achieved 47.0% and 41.1% lower CO 2 emissions compared to another two hospitals using fluorinated gas 36 .…”

SF6 compared to C2F6 for inferior rhegmatogenous retinal detachment repair; The Manchester Pseudophakic Retinal Detachment Study

“…1 To overcome this potential limitation, the use of long-acting gases, such as C 2 F 6 and C 3 F 8 , has been advocated in case of inferior retinal breaks because they provide longer inferior retinal support compared with SF 6 , despite several disadvantages, including prolonged postoperative visual disruption, cataract formation, and restriction in air travel and other high-altitude activities. [2][3][4] Although SF 6 and even air have been recently proposed as feasible tamponade agents in RD repair, [5][6][7] for inferior RDs, [7][8][9][10] the strength of the conclusion of these case series is significantly limited by the small sample size and the non-comparative observational design. 6,7,9,10 Specifically, although the only randomized control trial comparing air with C 3 F 8 tamponade report the noninferiority of air tamponade for inferior RD, they had a strong trend toward significance in favur of gas tamponade on multivariable regression.…”