Premature and very low birth weight (VLBW) neonates are subjected to many morbidities including retinopathy of prematurity (ROP) which may lead to retinal detachment and blindness. However, the number of infants identified with ROP has increased, apparently because of increased survival of VLBW infants rather than new iatrogenic factors. The present study was planned to show the effect of hyperglycemia (defined as blood glucose ≥150mg/dl) on ROP in premature and VLBW neonates. This analytical prospective cohort study was conducted on 65 premature and/or very low birth weight neonates admitted to the neonatal intensive care unit in Kasr El Ainy hospital along a period of 6 months starting from April to September 2010. Cases were divided into two groups: hyperglycemic (31 cases) and non-hyperglycemic group (32 cases). Fundus examination was performed to all patients within 4-6 weeks of birth and if fundus examination was normal follow up was done at 2-3 months, if abnormal; fundus was repeated every 2 weeks till the retina was fully vascalurized. Fourteen cases (45.2%) out of 31 case of hyperglycemia developed ROP, while only five cases (14.7%) without hyperglycemia developed ROP with highly significant P value=0.007 and odds ratio 4.776 at 95% confidence interval (1.46-15.60).Many risk factors for ROP were taken in the study, but only five factors were found to be independently significant variables by logistic regression tests: low gestational age, apgar score at 5 minutes, oxygen days, days of mechanical ventilation or continuous positive airway pressure (CPAP) and phototherapy. In conclusion, hyperglycemia is a risk factor for ROP therefore early and proper glucose adjustment in the first week of life may decrease incidence of ROP.