In some cases of stage 4 retinopathy of prematurity (ROP), especially stage 4B, the temporal retina may be dragged in the retrolental space. Placement of sclerotomies in the temporal half may endanger hitting the retina directly. We describe a novel “all-nasal” approach for 25-gauge lens sparing vitrectomy (LSV) in such eyes. The surgeon sat nasal to the eye being operated. Infusion was placed along the horizonal between the superonasal and inferonasal ports for the vitreous cutter and endoilluminator. The rest of the steps of LSV were performed in a standard fashion. Till date we have operated eight eyes with stage 4B ROP with this approach. All surgical objectives could be achieved with this technique. Lensectomy could be avoided in seven of the eight eyes (87.5%). The all-nasal approach for LSV appears to be effective in avoiding lensectomy in select cases of stage 4B ROP, with good anatomical outcomes.