As our surgical techniques improve we are able to achieve anatomic retinal reattachment in 48% of eyes with advanced retinopathy of prematurity. Only 31% of these eyes, however, have achieved visual function by the six-month follow-up visit. In an attempt to determine the factors that lead to better visual outcome, we analyzed 85 eyes of 45 children who underwent surgical therapy for Stage V retinopathy of prematurity by one surgeon. These eyes were followed from 6 to 36 months. We analyzed the timing of surgery, retinal configuration, subretinal fluid composition, and appearance of retinal pigment epithelium following resolution of detachment as these related to visual results. We also used visual evoked response testing in an attempt to predict which eyes might achieve visual function. Children with best visual results tended to have rapidly regressing vascular activity, were operated earlier, and had little subretinal exudate sparing the macula and little alteration of RPE following retinal reattachment, and if measured, low iron concentration in subretinal fluid.