V-pattern and accommodative convergence/accommodation ratio in consecutive esotropia after surgery for intermittent exotropia: A comparison of bilateral lateral rectus recession and unilateral recession-resection.

ObjectiveTo delineate a clinically actionable phenotype of consecutive esotropia with V-pattern following surgery for intermittent exotropia and to determine whether the initial surgical approach-bilateral lateral rectus recession versus unilateral recession-resection-is associated with differential patterns of V-pattern presentation and accommodative convergence/accommodation behavior among patients who develop consecutive esotropia. Clarifying these associations may inform postoperative surveillance and the selection of secondary surgical strategies in consecutive esotropia complicated by pattern deviation.MethodsWe retrospectively reviewed patients who developed consecutive esotropia after surgery for intermittent exotropia and were evaluated/managed at our center between 2016 and 2024. Thirty-four patients with consecutive esotropia had previously undergone bilateral lateral rectus recession (bilateral lateral rectus recession group), and twenty-six had previously undergone recession-resection (recession-resection group). Intermittent exotropia stage and consecutive esotropia clinical data were extracted, including ocular motility (with emphasis on abduction limitation), refractive status, presence and magnitude of V-pattern, and accommodative convergence/accommodation ratio measured using the gradient method. Comparisons were performed between groups at each stage and within individuals across the intermittent exotropia-to-consecutive esotropia transition.ResultsBaseline distance exodeviation was comparable between groups (bilateral lateral rectus recession: 38.92 ± 12.78