From Innovation to Conservation: Sustainable Pathways in Vitreoretinal Practice

Vitreoretinal surgery, while clinically advanced and increasingly prevalent, presents a substantial environmental burden due to the widespread use of disposable instruments, fluorinated gases, and energy-intensive infrastructure. This narrative review explores sustainability in vitreoretinal practice, identifying key contributors to its carbon footprint and outlining strategies for mitigation. The environmental impact of tamponade agents-particularly sulfur hexafluoride (SF₆), with its extremely high global warming potential-is emphasized through data from recent multicenter studies. Additional contributors include inefficient gas delivery systems, single-use surgical instruments, and the disposal of persistent toxic substances. The article also addresses how expanding surgical indications and reliance on single-use technologies have compounded ecological costs. Evidence-based strategies for improving sustainability are discussed, including the use of air tamponade in selected cases, gas dilution protocols, adoption of single-use canisters, reusable instrumentation, optimized OR workflows, and teleophthalmology pathways that reduce unnecessary postoperative visits. Sustainable vitreoretinal surgery is presented not only as a possibility but as a clinical, ethical, and environmental imperative, achievable without compromising patient outcomes.