Comparing Global Operating Room Waste Generated From Cataract, Corneal, and Conjunctival Surgeries

To compare waste generated from corneal, conjunctival, and cataract surgeries globally to assess environmental sustainability within ophthalmology.

This prospective, multicenter observational study was conducted in 9 countries: Australia, Canada, Egypt, India, Italy, Mexico, Peru, Singapore, and the United States, in both hospital and surgical centers. Surgical waste data were collected from corneal (deep anterior lamellar keratoplasty [DALK], Descemet membrane endothelial keratoplasty [DMEK], Descemet stripping automated endothelial keratoplasty [DSAEK], penetrating keratoplasty [PK]), conjunctival (pterygium), and cataract surgeries. Centers followed standardized waste segregation protocols. Surgical, anesthesia, and corneal waste were weighed postoperatively. Data were analyzed using Kruskal-Wallis test with significance set at P < 0.05.

A total of 428 surgeries were evaluated: 278 corneal/conjunctival and 150 cataract. Significant intercountry differences in waste generation were found. India generated the least overall waste for DMEK (0.61 kg), DSAEK (0.49 kg), PK (0.62 kg), and cataract (0.48 kg) surgeries. The United States had the highest corneal waste for DMEK (0.28 kg) and DSAEK (0.24 kg); Peru had the highest for PK (0.35 kg). Peru also reported the highest waste for cataract (4.1 kg) surgeries. Countries producing less waste also used fewer disposable instruments and more reusable surgical items. No intraoperative complications or endophthalmitis were reported.

Substantial variability in ophthalmic surgical waste exists globally, with lower waste generation not associated with more frequent adverse outcomes. These findings suggest opportunities to reduce single-use practices and advance more sustainable ophthalmic surgery, although further study is needed to assess safety implications.