{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:29:50Z","timestamp":1764656990771,"version":"3.46.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Perfluoropropane (C\u2083F\u2088) and sulfur hexafluoride (SF\u2086) are established agents in vitreoretinal surgery. Their tamponade properties support anatomic success, but both gases have very high global warming potentials and extremely long atmospheric lifetimes. Given the health sector\u2019s considerable share of global greenhouse emissions, emissions attributable to intraocular gases constitute a discrete, measurable, and modifiable component of surgical practice. This Perspective synthesizes published evidence on the climate impact of C\u2083F\u2088 and SF\u2086 in routine vitreoretinal care and outlines actions at three levels. First, clinical practice: standardize low-concentration mixtures, match prepared volume to need, improve decanting technique, and consider air tamponade in appropriate indications. Second, implementation systems: training, checklists, and simple process metrics (prepared-to-injected ratios; concentration adherence) to reduce variation and waste. Third, institutional and policy measures: procurement criteria that favor lower GWP options and right sized packaging, guideline updates, audit indicators, and product level carbon disclosure. These steps do not introduce new clinical risk when applied with standard safeguards and may yield cost savings by reducing gas consumption. Because fluorinated intraocular gases are potent, long lived, and tied to modifiable routines, targeted measures in this niche can produce outsized gains for planetary health relative to effort.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1706042","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:26:10Z","timestamp":1764656770000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraocular gases and climate change: a call for sustainable vitreoretinal surgery"],"prefix":"10.3389","volume":"13","author":[{"given":"Joseph Paolo Y.","family":"Silva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Recivall P.","family":"Salongcay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S65","DOI":"10.1097\/IAE.0000000000002015","article-title":"The role of intraocular gas tamponade in rhegmatogenous retinal detachment: a synthesis of the literature","volume":"38","author":"Neffendorf","year":"2018","journal-title":"Retina"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1126\/science.259.5092.194","article-title":"Atmospheric lifetimes of long-lived halogenated species","volume":"259","author":"Ravishankara","year":"1993","journal-title":"Science"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e381","DOI":"10.1016\/S2542-5196(17)30162-6","article-title":"The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems","volume":"1","author":"MacNeill","year":"2017","journal-title":"Lancet Planet Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1038\/s41467-024-46084-3","article-title":"Sustained growth of sulfur hexafluoride emissions in China inferred from atmospheric observations","volume":"15","author":"An","year":"2024","journal-title":"Nat Commun"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1001\/jamaophthalmol.2023.3516","article-title":"Assessing strategies to reduce the carbon footprint of the annual meeting of the American Academy of ophthalmology","volume":"141","author":"McClintic","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/s00347-022-01792-3","article-title":"Position paper and recommendations for action for ecologically sustainable ophthalmology: statement of the German Society of Ophthalmology (DOG) and the German professional Association of Ophthalmologists (BVA)","volume":"120","year":"2023","journal-title":"Ophthalmologie"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"172921","DOI":"10.1016\/j.scitotenv.2024.172921","article-title":"Thermal degradation of greenhouse gas SF(6) at realistic temperatures: insights from atomic-scale CVHD simulations","volume":"931","author":"Li","year":"2024","journal-title":"Sci Total Environ"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1038\/s41433-023-02638-1","article-title":"Reducing our carbon footprint as vitreoretinal surgeons-what can we do as a group?","volume":"38","author":"Jawaheer","year":"2024","journal-title":"Eye (Lond)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"692","DOI":"10.4103\/IJO.IJO_1775_23","article-title":"Global warming impact of fluorinated gases in ophthalmic surgeries at a tertiary eye center in India","volume":"72","author":"Nadig","year":"2024","journal-title":"Indian J Ophthalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2763","DOI":"10.1007\/s00417-025-06905-7","article-title":"Carbon footprint of pars plana vitrectomies in rhegmatogenous retinal detachment in Germany between 2013 and 2023 - a cohort study of fluorinated gas emissions","volume":"263","author":"Strzalkowski","year":"2025","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0263009","DOI":"10.1371\/journal.pone.0263009","article-title":"Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: a multicentre study of 3,239 patients","volume":"17","author":"Moussa","year":"2022","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1038\/s41433-023-02639-0","article-title":"Reducing the use of fluorinated gases in vitreoretinal surgery","volume":"38","author":"Teh","year":"2024","journal-title":"Eye (Lond)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.3390\/ijerph21121548","article-title":"Contributions of medical greenhouse gases to climate change and their possible alternatives","volume":"21","author":"Wang","year":"2024","journal-title":"Int J Environ Res Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1706042\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:26:11Z","timestamp":1764656771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1706042\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":13,"alternative-id":["10.3389\/fpubh.2025.1706042"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1706042","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]},"article-number":"1706042"}}