To compare the effectiveness of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for pachychoroid neovasculopathy and neovascular age-related macular degeneration (AMD).Twenty-two eyes with pachychoroid neovasculopathy and 183 eyes with neovascular AMD were retrospectively included for analysis. All patients were treatment naive and received an initial series of 3 monthly loading injections of anti-VEGF, followed by further injections as required. The visual and anatomical outcomes after treatment were evaluated at 12 months from baseline.The pachychoroid neovasculopathy group showed a significant improvement in the mean best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution) from 0.50 ± 0.32 (Snellen equivalent; 20/63) to 0.31 ± 0.28 (20/85, P = 0.021), and a decrease in the mean central foveal thickness from 373 ± 184 μm to 195 ± 137 μm at 12 months (P < 0.001). No significant intergroup difference in the achieved improvement of BCVA and decrease of central foveal thickness was observed. However, compared with the neovascular AMD group, the pachychoroid neovasculopathy group showed lower proportions of patients requiring retreatment during the maintenance phase (59.1% vs. 80.9%, P = 0.018), longer treatment-free period after loading injections (6.1 vs. 4.3 months, P = 0.006), and fewer number of injections (4.2 vs. 4.9, P = 0.031).Anti-VEGF treatment for pachychoroid neovasculopathy showed a similar efficacy to anti-VEGF treatment for neovascular AMD in improving visual acuity during 12 months. However, eyes with pachychoroid neovasculopathy had a significantly lesser need for retreatment during the maintenance phase and longer retreatment-free period, while requiring fewer injections.