A 26-week-gestation boy weighing 675 g at birth and with multiple medical problems was transferred to our institution for treatment of presumed type 1 prethreshold ROP in the setting of prominent tunica vasculosa lentis. Although initial examination disclosed immature vessels in zone 2, he quickly progressed to stage 3 with plus disease by age 34 weeks. Given the patient's critically ill health, the neonatology service recommended against prolonged sedation for laser therapy. Therefore, after an informed discussion with his parents, light intravenous sedation was administered to the infant and his eyelashes and conjunctival surfaces were prepared with 10% povidone-iodine topical solution. Intravitreous injections of bevacizumab (0.75 mg/0.025 mL) were administered bilaterally using a separate, sterile eyelid speculum for each eye. The infant was examined on postinjection day 1 and then weekly for 2 months. Within 2 weeks, examination identified regression of the lens-associated vessels, disappearance of extraretinal fibrovascular proliferation, and marked regression of plus disease. Subsequently, radial vessels grew anteriorly within the retina.