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La maladie de Vogt-Koyanagi-Harada est dans sa forme typique une panuvéite bilatérale associée à des manifestations extraoculaires, méningées, cutanées et intéressant l'oreille interne. Sa distribution est inégale dans le monde, constituant une cause rare d'uvéite dans les populations européennes, mais très fréquente en Asie, dans les populations du bassin méditerranéen ou chez les Amérindiens. La maladie est présumée liée à une auto-immunité à médiation cellulaire dirigée contre les mélanocytes et certains allèles HLA de classe II sont plus fréquemment retrouvés chez les patients que dans la population générale.
L’étude rétrospective que nous avons réalisée sur 12 patients, suivis au service d’ophtalmologie A de l’hôpital des spécialités de Rabat, nous a menés aux conclusions suivantes :
- La moyenne d’âge était de 37 ans avec prédominance féminine de 58%.
- Tous nos patients étaient pigmentés.
- Le principal signe pathologique était la baisse de l’acuité visuelle dans 92% des cas.
- Il s’agit d’une uvéite granulomateuse chronique bilatérale associée à une atteinte neurologique, ORL et cutanée.
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- Le diagnostic est essentiellement clinique, l’angiographie à la fluorescéine et au vert d’indocyanine sont également utiles.
- Le traitement a reposé sur la corticothérapie, elle a donné de bons résultats, en permettant une amélioration de l’acuité visuelle moyenne avec un taux de récidive de 8,3%. Des complications ont survenu chez 33,33%.
- Il n’y a pas recours aux immunosuppresseurs en raison de l’absence de cas de corticorésistance et de formes récurrentes dans notre étude.
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Résumé
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Résumé
Titre : Etude rétrospective des 12 cas du syndrome de Vogt Koyanagi Harada. Auteur : Najoua Fqih.
Mots clés : VKH, uvéite, corticothérapie, immunosuppresseurs.
Dans ce travail, nous avons réalisé une étude rétrospective portant sur 12 cas pris en charge au service d’ophtalmologie A de l’hôpital des spécialités de Rabat sur une période de 11 ans, de Décembre 1999 à Avril 2010. Douze cas ont été recrutés parmi tous les patients hospitalisés pour bilan d’uvéite, ils étaient tous d’origine marocaine. Chaque patient a bénéficié d’un bilan clinique comprenant un interrogatoire et un examen clinique et d’un examen paraclinique complet.
La moyenne d’âge était de 37 ans avec une prédominance féminine de 58%. La grande majorité de nos patients provient de la région de Rabat et sont tous pigmentés. Le principal signe pathologique était la baisse de l’acuité visuelle, l’atteinte était bilatérale dans la majorité des cas (92%). Une dysacousie était marquée à 41,67%, des céphalées à 50%, et une atteinte de la peau et des phanères à 25%. La corticothérapie bien conduite a donné de bons résultats. L’évolution a été marquée par l’amélioration de l’acuité visuelle chez la majorité des patients. Durant le suivi, des complications ont survenu chez 4 patients soit 33,33%.
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En discussion nous avons comparé nos résultats à ceux de la littérature.
Ce travail fera partie d’un ensemble d’études qui seront conduites au sein du service d’ophtalmologie A de l’hôpital des spécialités de Rabat, et portant sur 12 cas de VKH. Il constituera également une introduction à une étude prospective qui doit être réalisée en collaboration entre l’ophtalmologiste, l’interniste, le neurologue et le dermatologue afin de répondre à des questions qui préoccupent l’ensemble des chercheurs travaillant sur ce sujet.
Summary
Title: Retrospective study of 12 cases of Vogt Koyanagi Harada syndrome. Author: Najoua Fqih.
Keywords: VKH, uveitis, corticosteroids, immunosuppressive.
In this work, we conducted a retrospective study of 12 cases taken up in the ophthalmology department of the hospital A specialty of Rabat on a 11-year period, from December 1999 to April 2010.
Twelve cases were recruited from all patients initially hospitalized for assessment of uveitis. They all received a clinical examination including an interview and a clinical examination, and complete paraclinical examination.
The average age was 37 years with a female predominance of 58%. The vast majority of our patients from the region of Rabat and are pigmented. The principal pathological sign was the decline in visual acuity; the achievement was bilateral in most cases (92%). A dysacousie was marked 41.67%, headache 50%,and a breach of the skin, hair and nails to 25%. Corticosteroids good conduct hasbeen successful. The evolution was marked by improvement of visual acuity in most patients. During follow-up, the complications have occurred in 4 patients is 33.33%.
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In discussion we have compared our results with those of literature. This work will be part of a series of studies to be conducted in the department of ophthalmology at the hospital specialties Rabat, and on 12 cases of VKH.
It will also provide an introduction to a prospective study to be carried out in collaboration between the ophthalmologist, internist, neurologist and dermatologist to address issues of concern to all researchers working on this.
صخله
ناونعلا : يعجر رثأب ةسارد نم 21 تلااح ةمزلاتم تغوف اداراه يغانايوك . فلوملا : ىوجن هيقف ةيسيئرلا تاملكلا : تغوف يغانايوك اداراه ، ،ةيحزقلا باهتلا ،تاديوريتسوكيتروكلا ةعانملل ةطبثملا . اذه ًف انٌرجأو ،لمعلا ةسارد ًعجر رثأب نم 21 ةلومشملا تلااحلا ةمدخ ًف نوٌعلا بط ًف ىفشتسم تاصصختلا طابرلا ىدم ىلع 22 ،اماع ربمسٌد نم 1999 ىلإ لٌربأ 1222 . دٌنجت مت 12 تلااح ىضرملا عٌمج نم مٌٌقتل ىفشتسملا ًف ،ةٌحزقلا باهتلا لصأ نم ًبرغم . عضخو ضٌرم لك مٌٌقتل ةٌرٌرسلا كلذ ًف امب ةلباقملا صحفلاو تاناحتملاا جئاتنو يرٌرسلا ةٌرٌرسلا . ناك طسوتم رمعلا 37 ةنس ةبلغ عم ثانلإا نم 85 ٪ . نم ىمظعلا ةٌبلاغلا اناضرم نم ةقطنم طابرلا مهو ةغبطصملا . ةملاعلا ةٌضرملا ةٌسٌئرلا تناك ًف ضافخنلاا ،رصبلا ةدح تناك ةباصلإا ةٌئانث مظعم ًف تلااحلا 92 ٪ . تزٌمت عمسلا نادقف دنع 41.67 عادصو ،٪ 50 ، ٪ ةباصإو ةرشبلا رفاظلأاو رعشلاو ىلا 18 ٪ . جلاعلا تادٌورٌتسوكٌتروكلاب احاجن ققح دق ةدٌج ةقٌرطب عبتملا . ىلع لوصحلا مت نٌسحت ا ةدح رصبل مظعم ادل ىضرملا . للاخ تثدح ،ةعباتملا ةرتف تافعاضم ًف 4 يأ ىضرم 33.33 ٪ . انراق ةشقانم ًف انلصوت ًتلا جئاتنلا كلت عم تاباتكلا . فوسو نوكٌ لمعلا اذه نم اءزج نم ةلسلس تاساردلا ىرجتس ًتلا مسق ًف نوٌعلا ةحارجو بط تاصاصتخلاا تاىفشتسم ًف ىلعو ،طابرلاب 12 ةلاح نم ًجاناٌوك اداراه تغوف .101 رفوتس اهنأ امك ةٌعلاطتسا ةساردل لاخدم نأ نواعتلاب ذفنت نٌب ،نوٌعلا بٌبط ،باصعلأا ًنطابلا بطلا ضارمأو ةجلاعملةٌدلج مهت ًتلا اٌاضقلا عٌمج نٌلماعلا نٌثحابلا لاجملا اذه ًف .
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