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To evaluate aflibercept treat-and-extend regimen for treatment of neovascular age-related macular degeneration in patients with limited response to ranibizumab.This prospective single-arm trial included 33 patients with neovascular age-related macular degeneration pretreated with treat-and-extend regimen ranibizumab for ≥6 months who failed to be extended to a 6-week interval at least twice. All patients received aflibercept (2 mg/0.05 mL) at baseline, and were subsequently treated according to treat-and-extend regimen, starting with a 4-week interval and extending in 2-week steps. Evaluations included mean maximum recurrence-free treatment interval; best-corrected visual acuity; central retinal thickness; and pigment epithelium detachment height and horizontal diameter.At Week 24, the maximum recurrence-free treatment interval increased to ≥6 weeks in ∼35% of patients, whereas the mean interval was 4.9 ± 1.3 weeks. Best-corrected visual acuity score remained stable, but significant reductions in central retinal thickness (P < 0.001) and pigment epithelium detachment height (P = 0.001) were observed compared with baseline, as was a small decrease in horizontal pigment epithelium detachment diameter (P = 0.035).After switching patients with limited ranibizumab response to aflibercept, signs of choroidal neovascularization activity regressed, and an increased duration of treatment effects was seen in approximately one-third of lesions, but visual acuity was unchanged.