The corneal endothelium is a barrier to fluid flow from the aqueous humor to the stroma. It is responsible for maintaining corneal transparency by regulating stromal hydration. The endothelial cell density decreases with age, and further damage to corneal endothelium by disease, trauma or drugs, may lead to its loss of function, which cause corneal edema, decreased corneal clarity, and loss of visual acuity. Therefore, keeping corneal endothelium healthy has a vital importance particularly for aged patients. Intravitreal injection causes significant concentration of VEGF inhibitors get into contact with human corneal endothelial cells. Previous studies indicated that VEGF and its receptors are expressed in the corneal endothelium and epithelium, and VEGF inhibitors can be detected in aqueous humour after intravitreal injection, both of which showing that VEGF inhibitors have potential to be cytotoxic to human corneal endothelial cells.The effect of the intravitreal injection of ranibizumab or bevacizumab on corneal endothelium has been studied before. Perez-Rico et al. reported that intravitreal injections of ranibizumab did not have significant effect on endothelial cell density, CoV, and Hex% at seven days or six months after the injection. The repeated intravitreal injections of ranibizumab over six months did not also cause substantial changes in the corneal endothelium. Chiang et al. evaluated human corneal thickness change and corneal endothelial cell density up to six months after intravitreal injection of 2.5 mg bevacizumab and found that intravitreal bevacizumab has no harmful effects on the corneal endothelium. In vitro studies also showed that bevacizumab is not toxic to corneal cells of human origin. Furthermore, although intracameral injection of ranibizumab caused deterioration in endothelial cell morphology in rabbit cornea, intracameral injection of bevacizumab did not affect endothelial cell viability or morphology in the rabbit or human cornea. Bevacizumab did not induce apoptosis or necrosis in human corneal endothelial and fibroblast cells in vitro. In a recent study, it was reported that monthly intravitreal bevacizumab or ranibizumab injections for three consecutive months does not affect corneal morphology and has no harmful effects on the endothelium in patients with diabetic macular edema. The findings of this present study also agree with these studies showing that neither ranibizumab nor bevacizumab has negative effect on corneal endothelial cells. The investigators found that the CCT, ECD, CoV, and Hex% did not change over six months after intravitreal injection of aflibercept in either eyes. Furthermore, the CCT, ECD, CoV, and Hex% did not show statistically significant difference between the eye treated with intravitreal aflibercept and contralateral untreated eye before and during 6-month follow-up after intravitreal injection.