PURPOSE: To examine the morphological changes in macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) after 2 years of aflibercept treatment under a treat-and-extend (T&E) regimen. METHODS: This retrospective study analyzed the medical records for 26 eyes of 25 patients diagnosed with treatment-naïve neovascular AMD and treated with aflibercept under a T&E regimen for 2 years. The areas of the MNV and vascular structures were assessed using swept-source optical coherence tomography angiography at baseline and after 2 years of treatment. RESULTS: The mean MNV area increased significantly from 0.65 ± 0.42 mm at baseline to 0.78 ± 0.45 mm at 2 years. At 2 years, the mean change in the MNV area from baseline was 22% (interquartile range: 4%–60%). The baseline MNV area was negatively correlated with the change ratio of the MNV areas at 2 years and baseline (R = −0.68, P < 0.001). Nine of the 26 eyes (34.6%) showed newly formed mature vessels, and seven eyes (26.9%) showed prominently developing preexisting mature vessels. CONCLUSION: MNV expanded and showed vascular maturation under aflibercept treatment with a T&E regimen. The smaller the MNV at baseline, the greater is its expansion in 2 years.