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Retinopathy of prematurity is a leading cause of childhood blindness. Once the disease progresses to stage IV, surgery is the only treatment option. At the regional pediatric ophthalmology center of the Bonum Scientific and Practical Center in Yekaterinburg, 26 patients with stage IVA retinopathy of prematurity underwent 32 operations: 25 during the active phase and seven during the cicatricial phase. The patient’s own clear lens was preserved in eight active-phase procedures. All patients underwent 20-gauge vitrectomy. Surgery stabilized the disease in 75% of cases, with complete retinal reattachment in 25%. Progression to stage V occurred in 25%. Following surgery during the active phase, progression was prevented in 70.3% of cases; complete retinal reattachment was achieved in 50% of lens-sparing vitrectomy cases.