PURPOSE: The natural course of the visual acuity in eyes with myopic macular neovascularization is poor. Intravitreal injections of anti-vascular endothelial growth factor agents have demonstrated safety and efficacy in the short term for managing myopic macular neovascularization. The purpose of this study was to determine the 4-year outcomes of intravitreal aflibercept injections. METHODS: A retrospective monocentric study including 49 eyes of 48 patients diagnosed with myopic macular neovascularization. These patients underwent treatment with intravitreal aflibercept using the pro re nata regimen after the first injection. The minimum follow-up duration was 4 years. RESULTS: The patients had an average age of 63.8 years and an average axial length of 29.7 mm. The mean number of intravitreal aflibercept injections was 1.6, and 30 eyes (61.2%) had a single injection. At the baseline and at 1, 2, 3, and 4 years, the mean best-corrected visual acuities were 20/45, 20/41, 20/43, 20/51, and 20/53, respectively. The differences in the best-corrected visual acuity at the different times from that at the baseline were not significant. CONCLUSION: Intravitreal aflibercept therapy with the pro re nata regimen provides a 4-year visual benefit in eyes with myopic macular neovascularization, and it is better than the reported natural course in maintaining the best-corrected visual acuity.