Importance: To evaluate the natural history and outcomes of infants with stage-3 retinopathy of prematurity (ROP) persisting beyond 40-weeks of postmenstrual age (PMA). Background: There are no specific screening guidelines for stage-3 ROP persisting beyond 40 weeks of PMA. Persistent stage-3 disease in zone II without plus disease or in zone III with or without plus disease poses a dilemma for treatment. Design: Retrospective chart review. Participant: Neonates with stage-3 ROP persisting beyond 40-weeks of PMA. Methods: Demographic data and ROP parameters were collected. Univariate/ multivariate analyses were utilized to assess risk factors associated with requiring treatment. Main Outcome Measures: Evaluating the structural outcomes for infants with stage-3 ROP persisting beyond 40 weeks of PMA. Results: Out of 2356 screened infants, 115 infants (4.9%, 172 eyes) met inclusion criteria. In 95 infants (139 eyes, 80.8%), ROP resolved spontaneously. Twenty-one infants (33 eyes, 19.2%) were treated with laser-photocoagulation; 16 eyes had reached type 1 ROP and 17 eyes had non-type 1 ROP. No eye had unfavourable structural outcome. On multiple regression, non-type 1 ROP with ≥2 continuous clock hours of persistent stage-3 temporally crossing the horizontal midline was a significant risk factor associated with receiving treatment (OR = 27.29, 95% CI = [1.61, 462.92], P = .0221). Conclusion and Relevance: The majority of stage-3 ROP persisting beyond 40-weeks of PMA resolve spontaneously. In eyes that do not reach type 1 ROP, ≥2 continuous clock hours of persistent stage-3 crossing the temporal horizontal midline and history of pre-plus were considered important risk factors for macular drag and treatment can be considered.

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