Purpose <p>To analyze environmental sustainability in vitreoretinal surgery and evaluate evidence-based strategies for reducing carbon footprint while maintaining optimal patient outcomes.</p> Methods <p>Literature review using PubMed and Google Scholar databases focusing on vitreoretinal surgery’s environmental impact and sustainable practices.</p> Results <p>Vitreoretinal surgery generates significant carbon emissions through disposable equipment, building energy consumption, and tamponade gas utilization. Fluorinated gases represent the most environmentally damaging component, with SF₆ demonstrating 22,800 times greater global warming potential than CO₂. Despite being used in only 38.6% of procedures, SF₆ was responsible for 68.8% of total emissions in vitreoretinal surgery, demonstrating a 4.4-fold greater environmental impact compared to C₂F₆. Air tamponade offers up to 47% emission reductions for appropriate cases, while alternative gas selection achieves 50% reductions when longer-acting tamponades are necessary. Energy optimization protocols, waste segregation improvements, and packaging modifications provide additional reduction opportunities.</p> Conclusion <p>Sustainable vitreoretinal surgery is feasible through evidence-based strategies that significantly reduce environmental impact without compromising patient safety. Key interventions include implementing air tamponade for appropriate cases and selecting alternative fluorinated gases with lower environmental impact. Implementation requires addressing regulatory barriers and cultural resistance through education programs and policy reform. The specialty should adopt the "5 R" framework for sustainable practice.</p>