Retinopathy of prematurity (ROP) is a proliferative vascular disease affecting the retina in preterm infants, characterized by abnormal capillary growth. It is a leading cause of visual impairment and blindness in infants and young children worldwide. The incidence of ROP has increased due to global trends in premature births and improved neonatal care. This review aims to present the pathophysiological mechanisms of ROP, including its treatment, with a focus on hypoxia and redox signaling pathways. ROP is classified into four zones based on retinal vascularization status and five stages based on severity. Key risk factors include low gestational age, low birth weight, prolonged mechanical ventilation, and maternal conditions such as hypertension and gestational diabetes. Screening guidelines vary by region, but universal screening is recommended for infants born at or before 30 weeks gestation or with a birth weight less than 1500 grams. The natural course of ROP includes stages 1 to 5, with stage 1 regression occurring in about 90% of cases. Treatment options include cryotherapy, laser photocoagulation, and anti-VEGF therapy. Cryotherapy and laser photocoagulation aim to prevent retinal detachment and abnormal angiogenesis, while anti-VEGF therapy targets VEGF signaling to reduce neovascularization. Recent research has explored novel treatment approaches targeting hypoxia and redox signaling pathways. These include antioxidant strategies, modulating the Nrf2 pathway, inhibiting the STAT3 signaling pathway, and targeting HIF-1α and VEGF. Additionally, stanniocalcin-1, a potential anti-inflammatory molecule, and matrix metalloproteinases (MMPs) have shown promise in preclinical studies. The review highlights the importance of understanding the pathomechanisms of ROP to develop innovative treatments and improve outcomes for affected infants.Retinopathy of prematurity (ROP) is a proliferative vascular disease affecting the retina in preterm infants, characterized by abnormal capillary growth. It is a leading cause of visual impairment and blindness in infants and young children worldwide. The incidence of ROP has increased due to global trends in premature births and improved neonatal care. This review aims to present the pathophysiological mechanisms of ROP, including its treatment, with a focus on hypoxia and redox signaling pathways. ROP is classified into four zones based on retinal vascularization status and five stages based on severity. Key risk factors include low gestational age, low birth weight, prolonged mechanical ventilation, and maternal conditions such as hypertension and gestational diabetes. Screening guidelines vary by region, but universal screening is recommended for infants born at or before 30 weeks gestation or with a birth weight less than 1500 grams. The natural course of ROP includes stages 1 to 5, with stage 1 regression occurring in about 90% of cases. Treatment options include cryotherapy, laser photocoagulation, and anti-VEGF therapy. Cryotherapy and laser photocoagulation aim to prevent retinal detachment and abnormal angiogenesis, while anti-VEGF therapy targets VEGF signaling to reduce neovascularization. Recent research has explored novel treatment approaches targeting hypoxia and redox signaling pathways. These include antioxidant strategies, modulating the Nrf2 pathway, inhibiting the STAT3 signaling pathway, and targeting HIF-1α and VEGF. Additionally, stanniocalcin-1, a potential anti-inflammatory molecule, and matrix metalloproteinases (MMPs) have shown promise in preclinical studies. The review highlights the importance of understanding the pathomechanisms of ROP to develop innovative treatments and improve outcomes for affected infants.