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Background and Importance Neovascular age-related macular degeneration (nAMD) is the leading cause of vision loss in older adults. Anti-vascular endothelial growth factor (anti-VEGF) therapies have substantially improved outcomes in this population. With several agents available, comparative evidence is essential to inform clinical decision making.Aim and Objectives To perform a network meta-analysis (NMA) assessing the efficacy and safety of anti-VEGF agents for nAMD.Material and Methods A PubMed search was conducted to identify phase III randomised controlled trials (RCTs) evaluating ranibizumab, brolucizumab, aflibercept, and faricimab in nAMD. Baseline characteristics included age, sex, race, best-corrected visual acuity (BCVA), and central subfield thickness (CST).The primary efficacy endpoint was mean change in BCVA, measured using the ETDRS letter score. Analyses were performed with R v4.4.1. Anti-VEGF agents were compared using aflibercept 2mg Q8W as the reference.Results Nine RCTs were included. Populations were comparable: mean age similar across trials, women represented approximately 55% of patients, baseline BCVA ranged 50–60 letters, and CST 350–460 μm.At week 48, all active regimens yielded similar improvements in BCVA. The greatest numerical gain was observed with aflibercept 2 mg Q4W (SMD 0.93, 95% CI -1.22, 3.07), though not statistically significant. Verteporfin (SMD -19.81, 95% CI -22.77, -16.85), was associated with marked visual decline.Regarding safety, the highest odds ratios (OR) for serious ocular adverse events were reported with aflibercept 8 mg Q12W (OR 3.05, 95% CI 0.61, 15.20) and Q16W (OR 2.51, 95% CI 0.48, 13.02), though with wide confidence intervals. Brolucizumab 6 mg Q12W (OR 2.86, 95% CI 1.20, 6.85) was the only regimen with a statistically significant increase in risk. Elevated but uncertain risks were also observed with brolucizumab 3 mg Q12W and ranibizumab 0.5 mg Q4W.Conclusion and Relevance This NMA confirms that anti-VEGF therapies are significantly more effective than verteporfin photodynamic therapy in preserving visual acuity in nAMD. No major safety differences were observed for most agents, although brolucizumab 6 mg Q12W may carry a higher risk of ocular adverse events. Further long-term studies are needed to clarify comparative outcomes.Conflict of Interest No conflict of interest