Purpose <p>We previously reported 1-year outcomes of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept (IVA) in treatment-naïve pachychoroid neovasculopathy (PNV). In this study, we evaluated the 2-year outcomes of HFPDT combined with IVA in treatment-naïve PNV without polypoidal lesions.</p> Study design <p>Retrospective, interventional case series</p> Methods <p>We retrospectively studied 61 eyes with treatment-naïve PNV that received HFPDT combined with IVA and were followed for at least 2 years. Additional treatments were given if a dry macula was not achieved or if exudation recurred. We evaluated the best-corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), and macular neovascularization thickness (MNVT). Factors associated with additional treatment were also analyzed.</p> Results <p>BCVA was significantly improved at 1 year (<i>P</i> &lt;.05), but not at 2 years (<i>P</i> = .07). FT, CCT, and MNVT significantly decreased throughout the study period (all <i>P</i> &lt;.01). A dry macula without further treatment was maintained in 44% of the eyes. These eyes were significantly younger (<i>P</i> &lt;.01), with lower MNVT (<i>P</i> &lt;.01) and greater CCT (<i>P</i> &lt;.05) at baseline. Logistic regression identified age and MNVT as significant factors for additional treatment. PDT-induced acute exudative maculopathy (PAEM) was observed in 26.5% of the eyes requiring additional treatment, but not in those without retreatment.</p> Conclusion <p>HFPDT combined with IVA for treatment-naïve PNV maintained a dry macula for 2 years with initial treatment alone in 44% of the cases. Age, MNVT, and PAEM were associated with the need for additional treatment.</p>