Evaluation of retinal vasculature in hepatitis C patients after the national program for treatment

Purpose To describe retinochoroidal vascular alterations in patients treated through Egypt’s National Treatment program for hepatitis C using en face optical coherence tomography angiography (OCTA). Patients and methods This cross–sectional study included 60 patients (120 eyes) with a history of hepatitis C virus (HCV) infection, aged 34–61 years, who had achieved sustained virologic response after treatment with direct-acting antivirals. Exclusion criteria included ocular diseases, diabetes, or systemic conditions affecting microvasculature. Retinal and choroidal vascular parameters were assessed using OCTA, including superficial vessel density (SVD), deep vessel density (DVD), foveal avascular zone area, and subfoveal choroidal thickness. Data were analyzed by age subgroup and compared with previous studies. Results Patients demonstrated a significant reduction in retinal SVD and DVD, particularly in parafoveal areas, and a larger foveal avascular zone compared with normative data ( P <0.05). Subfoveal choroidal thickness was notably thinner, correlating with age and treatment duration. Age subgroup analysis revealed greater vascular alterations in older patients (≥50 years), with reductions in parafoveal SVD and DVD being most pronounced. Comparative studies indicate similar trends in microvascular alterations in treated HCV populations, though variations exist due to demographic and methodological differences. Conclusion En face OCTA reveals significant retinochoroidal vascular changes in post-HCV treatment patients, with age-related exacerbation. These findings suggest that microvascular remodeling persists despite viral eradication, emphasizing the need for long-term ocular monitoring. Further studies are warranted to explore underlying mechanisms and potential clinical implications.