Background: In preterm infants with severe retinopathy of prematurity, there is often a discrepancy between ophthalmic ultrasound findings and the ophthalmoscopic and/or intraoperative aspect of the eye. Methods: Six preterm infants (8 eyes) with stage-5 retinopathy of prematurity were examined with standardized ophthalmic echography (A and B scans) shortly before undergoing open-sky vitrectomies. Sonographic findings were evaluated according to four A-scan and four B-scan criteria used to diagnose retinal detachment in adults and compared to intraoperative findings. Results: Although the retinal detachments and vitreal proliferation found in all 8 eyes at surgery were almost identical, the sonographic aspects varied widely: 3/8 satisfied most of the criteria used in adults, 3/8 presented two criteria only and the remaining 2 were negative for all criteria used. Conclusion: The variability in the ultrasonographic aspects of these preterm eyes may depend on the degree of maturity of the preterm retina at the time of examination, with more mature retinas presenting greater reflectivity and therefore greater visibility in the sonographic exam.