Aim — to develop the methodology of early primary vitrectomy for aggressive posterior retinopathy of prematurity. Material and methods. The study included 10 preterm infants (20 eyes; gestational term — 26—30 weeks, post-conceptual age — 34—39 weeks) with severe forms of aggressive posterior retinopathy of prematurity (AP-ROP). All patients underwent a complex ophthalmic examination. Their results were compared with retrospective data of earlier treated AP-ROP patients (10 preterm infants, 20 eyes), in whom laser photocoagulation (LC) was done first (gestational period at the time of LC ranged from 26 to 30 weeks, post-conceptual age — from 34 to 39 weeks). In all cases, the disease progressed despite LC, thus, second-stage vitrectomy was required. Taking into account the similarity between clinical and morphometric data of the study group and retrospective patients, laser treatment was voted inexpedient as predictably inefficient and, therefore, a decision was made to perform vitreoretinal surgery. For that, an original technique of vitrectomy without preliminary LC was designed. Follow-up periods were up to 6 months. Results. In all cases, AP-ROP regression to inactive stage was diagnosed 1 month after vitrectomy. According to digital retinoscopy findings, initial sings of blood vessel growth into the previously avascular retina appeared on day 20—26 after surgery. This was confirmed by the results of fluorescein angiography. In general, complete retinal reattachment was obtained in 16 eyes (80%), partial — in 3 eyes (15%). In 1 case, the retina failed to reattach (5%). Conclusion. The proposed method of primary vitrectomy enables optimization of the treatment approach to severe AP-ROP and can be regarded as promising.