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Background and Importance Anti-vascular endothelial growth factor (anti-VEFG) agents are the standard of care for neovascular retinal diseases such as age-related macular degeneration (nAMD), diabetic macular oedema (DME), and retinal vein occlusion (RVO). In the last 5 years, new molecules, extended dosing intervals, and real-world data have reshaped clinical practice.Aim and Objectives To analyse the evolution of intravitreal anti-VEGF drugs in clinical practice in a secondary-level hospital over the last 5 years.Material and Methods Retrospective observational study including all dispensations of aflibercept, brolucizumab, faricimab, and ranibizumab from 2020 to 2024. The number of patients and dispensations for each drug were analysed globally and by diagnosis, as well as the treatment cost per patient per year. Data were obtained from the outpatient dispensing record Farmatools and analysed in an Excel database.Results Over the last 5 years, 18,735 intravitreal anti-VEGF doses were dispensed: 2020: 1,264; 2021: 3,637; 2022: 4,202; 2023: 4,710 and 2024: 4,922. The number of patients treated was 567, 716, 807, 860, and 929, respectively.Classified by drug and year:2020: aflibercept 369 patients (453 injections); ranibizumab 198 patients (811 injections).2021: aflibercept 495 patients (2,617 injections); ranibizumab 221 patients (1,020 injections).2022: aflibercept 612 patients (3,218 injections); brolucizumab three patients (11 injections); ranibizumab 192 patients (973 injections).2023: aflibercept 739 patients (4,133 injections); brolucizumab three patients (20 injections); ranibizumab 118 patients (557 injections).2024: aflibercept 806 patients (4,464 injections); brolucizumab three patients (10 injections); faricimab 94 patients (321 injections); ranibizumab 37 patients (127 injections).Classified by most frequent diagnoses and drug:Aflibercept: nAMD (44.7–53.9%), DME (24.7–33.9%), RVO (21.2–22.1%).Ranibizumab: nAMD (60.1–71.1%), DME (18.4–25.9%), RVO (9.9–14.5%).Brolucizumab (2022–2024): nAMD 66.7%, DME 33.3%.Faricimab (2024): nAMD 56.4%, DME 43.6%Annual treatment cost per patient was €854.6, €927.7, €1,204.7, €1,338.5, and €1,225.2 in 2020, 2021, 2022, 2023, and 2024, respectively.Conclusion and Relevance The number of patients has gradually increased, while the number of doses has almost quadrupled. By drug, aflibercept use has increased, ranibizumab use has declined, brolucizumab has shown only occasional use, and faricimab use cannot yet be assessed due to its recent introduction. It is necessary to evaluate real-world data and position the use of these drugs due to the ageing of the population, their chronic administration and the economic impact involve.Conflict of Interest No conflict of interest