Selective potassium titanyl phosphate laser-assisted endoscopic dacryocystorhinostomy with cyanoacrylate flap fixation: A prospective comparative study

Purpose: To compare intraoperative blood loss and surgical success between potassium titanyl phosphate (KTP) laser-assisted and conventional cold steel endoscopic dacryocystorhinostomy (enDCR). Methods: Design: Prospective, non randomized comparative interventional study. Setting: Single tertiary referral center. Patients: Adults with primary acquired nasolacrimal duct obstruction were prospectively enrolled between March 2023 and June 2024. Intervention: Patients were assigned to either KTP laser-assisted enDCR or cold steel enDCR, differing only in the method of nasal mucosal incision. In both groups, bone removal and lacrimal sac opening were performed with cold steel instruments, and mucosal flaps were secured using 2-octyl-cyanoacrylate adhesive. Main outcome measures: The primary outcome was surgical success at 9 months. Secondary outcomes included intraoperative blood loss and adhesive-related complications. Results: A total of 73 procedures were analyzed (cold steel: 36; KTP: 37). The KTP group demonstrated significantly lower median intraoperative blood loss compared to the cold steel group (0.05 g vs. 0.36 g; P < 0.001). Surgical success rates at 9 months were comparable between the two techniques (94.6% in the KTP group vs. 97.2% in the cold steel group; P = 1.000). No complications related to the cyanoacrylate adhesive were observed. Conclusions: Selective use of the KTP laser for mucosal incision, combined with cyanoacrylate flap fixation, significantly minimizes intraoperative bleeding while achieving high surgical success rates comparable to traditional cold steel enDCR.