■ BACKGROUND AND OBJECTIVE: To evaluate the use of intravitreal pegaptanib in the treatment of choroidal neovascularization secondary to age-related macular degeneration (AMD) in treatment-naïve patients. ■ PATIENTS AND METHODS: In a consecutive, retrospective case series, treatment-naïve patients with exudative AMD were treated with intravitreal pegaptanib. Intravitreal injections were typically given every 6 weeks at the discretion of the treating physician. Snellen visual acuity (VA), clinical course, and adverse events were monitored. A minimum of three pegaptanib injections were given. Retreatment criteria included persistent submacular fluid, macular edema, new macular hemorrhage, and loss of vision. ■ RESULTS: The average change in VA for all lesions was a loss of 2.9 lines. Fifteen (14%) patients gained more than 3 lines of VA. The average number of injections was 4.8. Ninety-two of 111 lesions were able to be categorized by size. Sixty-six patients had small lesions (< 4 disc areas) with an average change of -2.0 lines, and 26 had large lesions (≥ 4 disc areas) with an average change of -5.4 lines (P < .02). Patients with larger lesions were at greater risk for severe visual loss (P < .01). The average follow-up was approximately 31 weeks (range: 12 to 82 weeks) after the first injection. ■ CONCLUSIONS: Pegaptanib therapy resulted in a 2.9 average line loss in patients when all lesions were considered. Small lesions responded favorably, with 15% of patients gaining more than 3 lines of VA. Larger lesions had an increased risk of progression and poor visual outcome.