Objective To assess the anatomical and visual outcomes of stage 4A retinopathy of prematurity (ROP) after lens-sparing vitrectomy.Methods It was a retrospective case series study.Twenty eyes of 15 infants with stage 4A ROP were identified and underwent lens-sparing pars plana vitrectomy under anesthesia.Anatomical outcomes were assessed with an indirect binocular ophthalmoscope and RetCam Ⅱ imaging system at the follow-up visit.Visual outcomes were measured with a grating acuity test (Lea gratingTM).Results All twenty eyes had complete retinal reattachment after surgery.Three eyes had distortion or dragging of the macula (15％).The macula appeared to be normal in the remaining eyes (85％).Twelve eyes of 9 infants were successfully measured with a grating acuity test.Average grating acuity was 6.4±2.5 cpd (2-12 cpd),which was 4.29±0.20 (3.82～4.60) when transformed to optotype acuity values.Two eyes had distortion or dragging of the macula.The visual acuity of these 2 eyes was 3.82 and 4.0,respectively.Visual acuity of the remaining eyes was 4.3 or better.Conclusion Patients with stage 4A ROP retinal detachment can be treated successfully with respect to anatomical and visual outcomes utilizing lens-sparing vitrectomy.