Bleb-like retinal detachment (BLRD) in posterior zone 1 retinopathy of prematurity (ROP) presents a significant therapeutic challenge and is associated with a guarded visual prognosis. We present a case of a female infant born preterm with a birth weight of 1100 g. Examination revealed bilateral stage 4 aggressive ROP in posterior zone 1 with BLRD. Given the extent of retinal detachment, a combination of bilateral intravitreal bevacizumab injection, followed by lens-sparing vitrectomy surgery was performed. The baby tolerated the procedures well. The initial postoperative course was uneventful, and the child showed good anatomical and visual success. Through this case, we aim to discuss the risk factors associated with BLRD in ROP, the specific treatment challenges encountered and the potential treatment outcomes.