Deproteinized calf blood extract With or without punctal plugs versus preservative-free sodium hyaluronate for glaucoma-associated ocular surface disease: a three-arm randomized controlled trial
In brief
Calf extract plus plugs showed no confirmed surface benefit; pressure was 1.9 mmHg lower
In this 60-patient trial, symptoms and corneal staining improved numerically with calf blood extract, especially when combined with punctal plugs, but differences from hyaluronate were not significant after correction for multiple comparisons. Eye pressure was 1.9 mmHg lower with extract plus plugs at two months, an exploratory finding that does not show the treatment improves glaucoma control.
- Journal
- Frontiers in medicine (Q1)
- Published
- 25 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Xiao Ma, XiaoXia Li
- PMID
- 42856580
- DOI
- 10.3389/fmed.2026.1881940
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 12 October 2026): DCBE ± plugs improves ocular surface metrics in glaucoma patients
Abstract
INTRODUCTION: To evaluate the short-term clinical outcomes of deproteinized calf blood extract (DCBE) with or without punctal plugs compared with preservative-free sodium hyaluronate in patients with ocular surface disease (OSD) associated with long-term anti-glaucoma therapy. METHODS: Sixty patients were randomly assigned to one of three groups: Group I (DCBE plus punctal plugs), Group II (DCBE alone), and a control group (preservative-free 0.1% sodium hyaluronate). All patients continued their anti-glaucoma regimens throughout the study. Ocular symptoms, tear film parameters, and intraocular pressure (IOP) were assessed at baseline, one month, and two months post-treatment. RESULTS: Numerical improvements in OSDI, TBUT, and CFS were observed in the DCBE-treated groups during follow-up. At 2 months, the difference between Group I and the control group favored Group I for OSDI (mean difference, -10.82; 95% CI, -20.80 to -0.84) and CFS (mean difference, -0.70; 95% CI, -1.33 to -0.07), but neither remained statistically significant after correction for multiple comparisons (Holm-adjusted P = .104 and.091, respectively). No significant between-group difference in TBUT was observed. Schirmer I test and meibum scores also did not differ significantly between Group I and the control group. At 2 months, IOP was lower in Group I than in the control group (mean difference, -1.90 mmHg; 95% CI, -3.10 to -0.70; Holm-adjusted P = .009); this was considered an exploratory finding. CONCLUSION: DCBE-based treatment was associated with favorable short-term changes in several ocular surface outcomes in glaucoma-associated OSD. Addition of punctal plugs was associated with favorable numerical changes, although significant between-group ocular surface differences were not demonstrated after correction for multiple comparisons. The observed IOP reduction was exploratory and should not be interpreted as evidence that OSD treatment directly improves IOP control.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.