Clinical Characteristics and Surgical Outcomes of Acute Acquired V-Pattern Esotropia: A Comparative Study Highlighting Novel Demographics, Refractive Profiles, and Superior Sensory Recovery.

PURPOSE To characterize the clinical profile, surgical outcomes, and prognostic factors of acute acquired V-pattern esotropia (AAVE), a rare, understudied subtype of strabismus, and compare its features to classic V-pattern esotropia (VE). METHODS In this retrospective cohort study, 37 AAVE and 39 VE patients underwent standardized surgical correction. Outcomes included alignment, stereoacuity, and refractive status. RESULTS Compared to VE, AAVE patients were significantly older at onset (8.5 vs. 3.0 years, p < .0001), exhibited milder hyperopia (+0.68D vs. +2.90D, p < .0001), and presented with larger preoperative esodeviations (44.1 vs. 36.8 PD, p = .0109). After 1-year follow-up, stereoacuity recovery was superior in AAVE patients (80.8% achieving good stereoacuity vs. 37.9% in VE; p = .0127), though surgical success rates did not differ significantly (73.0% vs. 64.1%, p = .4057). CONCLUSION AAVE represents a distinct diagnostic entity marked by acute onset, older age, and superior postoperative sensory recovery. Its unique refractive profile and association with modern near-work stressors raises consideration of modern visual stressors in pattern strabismus, supporting consideration of early surgical intervention to maximize binocular potential. These findings suggest that AAVE represents an important subtype in pediatric ophthalmology, supporting the need for updated clinical guidelines.