Retinopathy of prematurity (ROP) is a serious ophthalmic disease threatening the vision of premature infants, characterized by abnormal retinal vascular development and pathological neovascularization. Its pathogenesis follows a two-stage model of “early hyperoxia inhibiting angiogenesis - late hypoxia promoting neovascularization,” in which oxidative stress damage, inflammatory immune activation, and abnormal expression of growth factors such as vascular endothelial growth factor and insulin-like growth factor-1 play key roles. Current studies indicate that the occurrence of ROP is closely associated with maternal factors (such as gestational hypertension, diabetes, smoking during pregnancy) and fetal factors (including low birth weight, low gestational age, inappropriate oxygen therapy, anemia, blood transfusion, multiple pregnancies, nutritional imbalances, infections, and genetic susceptibility), among which low birth weight and low gestational age are independent risk factors, while the clinical management of oxygen therapy parameters (duration, concentration, and fluctuations) is particularly important. Given the rapid progression, high blindness rate, and poor prognosis of ROP, there is an urgent need to achieve early precise identification and intervention through multifactorial integration models. Future research should further explore the interaction mechanisms of risk factors and develop individualized prevention and treatment strategies to improve the long-term quality of life for affected children.