Comparison of Outcomes and Postoperative Satisfaction Between Laser-Assisted and Conventional Open Dacryocystorhinostomy: A Prospective Comparative Study

Purpose: To compare the outcomes, postoperative recovery, and patient satisfaction between transcanalicular diode laser-assisted dacryocystorhinostomy (laser DCR) and conventional external dacryocystorhinostomy (external DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). Methods: This prospective comparative study included 189 patients (103 laser DCR, 86 external DCR) with PANDO. Outcome measures included surgical success (anatomical patency and resolution of epiphora), operative time, intraoperative pain (VAS), time to return to work, cosmetic satisfaction, and overall patient satisfaction. Results: Surgical success at 12 months was comparable between laser DCR (89.3%) and external DCR (91.8%) (p=0.55). Laser DCR demonstrated significantly lower intraoperative pain (VAS 3.2 vs 5.7, p<0.0001), shorter operative time (19.8 vs 26.7 minutes, p<0.0001), and earlier return to work (3.4 vs 8.6 days, p<0.0001). Patients reported higher cosmetic satisfaction following laser DCR. However, costs were higher for laser DCR due to equipment and maintenance. Conclusion: Both external and laser DCR provide high success rates for PANDO. Laser DCR offers distinct advantages in terms of pain, cosmesis, and recovery, making it an attractive alternative where resources allow. External DCR remains the gold standard, particularly in revision or complex cases.