Posterior hyaloid peeling in advanced stages of aggressive posterior ROP. 
To evaluate the indications and timing of surgical intervention on eyes with aggressive posterior retinopathy of prematurity (ROP).  Retrospective review of a consecutive case series of 9 eyes of 7 children, with aggressive posterior ROP, who underwent early lens-sparing vitrectomy.  Preoperative retinal and vitreal features, intraoperative and postoperative complications, postoperative anatomic status, and fixation behavior 1 year after surgery were investigated.  Vitreous hemorrhage and recurrence of plus disease with retinal detachment were the main indications for surgery.  Vitrectomy was performed from the 37th to the 44th postmenstrual week (mean 40th week).  In 7 eyes, vitrectomy could stop the disease progression.  In all of these cases, posterior hyaloid could be peeled together with the proliferative tissue.  Lens-sparing vitrectomy with posterior hyaloid peeling at early postmenstrual ages (37-40 postmenstrual weeks) seems to be advantageous in infants with aggressive posterior ROP.  The formation of a gliotic membrane growing ahead to the posterior surface of the lens resulted in unfavorable outcomes in our cases.