Evaluating the Efficacy and Safety of Topical Difluprednate in Patients with Chronic Central Serous Chorioretinopathy
In brief
Topical difluprednate clears subretinal fluid in 90% of chronic CSCR patients
In a small pilot trial, 90% of eyes treated with difluprednate achieved complete fluid resolution, compared with 45% on oral eplerenone and 23% observed. The steroid also reduced choroidal thickness and improved retinal sensitivity, while ocular hypertension occurred in 30% but was controllable with drops. These findings suggest a potent, eye-only option, though larger studies are needed to confirm safety and durability.
- Journal
- Retina (Philadelphia, Pa.) (Q1)
- Published
- 30 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Parul Yadav, Shakha, Sanjay Mishra, Kabiruddin Maula, Saurabh Verma, Devesh Kumawat, et al.
- PMID
- 42531436
- DOI
- 10.1097/IAE.0000000000004943
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 2 August 2026): Topical difluprednate for CSCR, ophthalmology focus
- Picked for Ophthalmology (top studies of the week, 2 August 2026): Topical difluprednate for chronic CSCR
Abstract
PURPOSE: To evaluate the efficacy and safety of topical Difluprednate ophthalmic emulsion 0.05% in chronic Central Serous Chorioretinopathy (cCSCR) and compare its outcomes with oral eplerenone and observation. METHODS: This pilot open-label randomised controlled trial included patients with cCSCR of ≥3 months' duration or relapsing cases with subfoveal or juxtafoveal leakage on angiography. After baseline assessment, patients were randomised into three groups: topical Difluprednate, oral Eplerenone, or observation. All participants were followed monthly for 3 months. Changes in best-corrected visual acuity, optical coherence tomography parameters, retinal sensitivity, and adverse events were documented. RESULTS: 53 adults (mean age 42.6 ± 9.5 years; 90.6% male) were enrolled. Complete resolution of subretinal fluid occurred in 90% (n=18) of the patients in the Difluprednate Group, 45% (n=9) in Eplerenone Group, and 23% (n=3) patients in the control arm (p < 0.001). The difluprednate group showed significantly greater reductions in subfoveal choroidal thickness (SFCT) and improvements in 3-mm microperimetry thresholds compared with the observation group (p = 0.012 and p = 0.022, respectively). It also demonstrated the largest decrease in central macular thickness, although this was not statistically significant (p = 0.19). Ocular hypertension developed in 30% of difluprednate-treated eyes and was controlled with topical antiglaucoma medication. CONCLUSION: Topical difluprednate produced superior anatomical and functional improvements in SRF resolution, SFCT reduction, and retinal sensitivity within 3-mm when compared with oral eplerenone and observation. Thus, with a manageable safety profile, it may serve as an effective therapeutic option for cCSCR.
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.