Background: Exudative, or “wet” age-related macular degeneration (wAMD), characterized by choroidal neovascularization and consequent accumulation of subretinal fluid, is the leading cause of visual loss in elderly patients in Western countries. Objective: To compare the effectiveness of aflibercept vs. ranibizumab for treatment-naive wAMD patients in the real world. Methods: PubMed, Web of Science and Cochrane Library were searched to compare aflibercept with ranibizumab. 21 studies with a total of 13,004 eyes were selected and assessed in this meta-analysis. Results: Compared to ranibizumab, aflibercept was more effective in improving best-corrected visual acuity (BCVA) at 12 months (WMD: ？0.04; 95% CI: ？0.07 to 0.00; p = 0.04). At 3 months, aflibercept was superior to ranibizumab in reducing central retinal thickness in patients with worse baseline BCVA (WMD: ？36.19; 95% CI: ？71.47 to ？0.92; p = 0.04), reducing subfoveal choroidal thickness in patients with better baseline BCVA (WMD: ？12.67; 95% CI: ？21.33 to ？4.02; p = 0.004), reducing height of subfoveal pigment epithelial detachment (WMD: ？43.88; 95% CI: ？73.88 to ？13.87; p = 0.004) and improving the incidence of “dry macula” occurrence (OR: 2.26; 95% CI: 1.33 to 3.82; p = 0.003). Conclusions: Compared with ranibizumab, aflibercept showed better efficacy in improving morphological changes at 3 months and visual acuity at 12 months post treatment initiation in community clinical setting.
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