Noncontact specular microscopy (Tomey EM-3000 Specular Microscope, Tomey Corp, Japan) was performed on the central cornea before the first intravitreal aflibercept injection and 1, 3, 6 months after the injection. A blinded observer (S.D.) obtained the corneal endothelial images. The specular microscope automatically evaluated the endothelial cell density (ECD), the coefficient of variation of the cell size (CoV), an objective measure of polymegathism, and the percentage of the hexagonal cells (Hex%), an index of pleomorphism. Specular microscopy also provided optical pachymetry measurements. The acute toxic of aflibercept on endothelium was evaluated by the the presence of corneal edema and anterior chamber reaction, and intraocular pressure on the first day after the injection. The nontreated eyes served as the control group.