This study aimed to determine the efficacy of combined vitrectomy and anti-VEGF injection for advanced stage 4 ROP with extensive neovascular proliferation (NF). The study included nine infants; six bilateral and three unilateral. Seven were female and the mean gestational age was 28.5 ±1.2 weeks. Mean birth weight was 1167 ±185g. Twelve eyes had laser treatment preoperatively. Indication for surgery was stage 4a in 13 eyes and 4b in two eyes. Surgery involved lens-sparing vitrectomy in 13 eyes and lensectomy with vitrectomy in two eyes. Endolaser photocoagulation was performed in eight eyes. Bevacizumab and ranibizumab were injected after fluid-air exchange in 12 and three eyes respectively. Follow-up after surgery was a mean of 27.2 ±2.36 weeks. Fibrovascular tissue regressed within two weeks for 14 eyes. Reactivation of fibrovascular tissue was noted in one eye. Total retinal detachment regressed in all eyes. There were no ocular complications or systemic adverse effects in any case over follow-up. Limitations are that this was a retrospective study in which anatomical outcomes were studied but not visual outcomes. This work warrants further study to evaluate the appropriate infant treatment dose.