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To assess long-term functional results after vitrectomy for stages 4 and 5 retinopathy of prematurity (ROP).Retrospective analysis of data from eyes that underwent lens-sparing vitrectomy (LSV) or combined lensectomy and vitrectomy (LV) and had a follow-up of at least 5 years.Eighty-eight eyes of 65 infants who underwent LSV or LV for stage 4 or 5 ROP were included in the study. The mean follow-up was 6.9 years. The anatomic success rate was 89% (17/19) for stage 4A, 63% (24/38) for stage 4B, and 42% (13/31) for stage 5. Forty-five eyes (51%) had measurable visual acuity (VA). The approximate Snellen VA equivalent was 20/550 for stage 4A, 20/1600 for stage 4B, and 20/4000 for stage 5. The remaining 39% (34/88) had light perception or no light perception. Owing to neurological conditions, VA in nine eyes (10%) could not be measured. Anatomic and visual outcomes were not associated with surgical technique.Surgery for stage 4A ROP has better visual success. Acceptable vision for stage 4B and poor for stage 5 ROP, despite retinal reattachment, is thought to be secondary to irreversible injury to either the retina or visual nervous pathways, or both.