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

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).

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

Systematic literature search.

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.

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.