To evaluate optical coherence tomography (OCT)-based intravitreal ranibizumab treatment for neovascular age-related macular degeneration (AMD), the charts of consecutive patients who received intravitreal ranibizumab for subfoveal choroidal neovascularization due to AMD were retrospectively reviewed. Patients with less than 6 months follow-up were excluded. OCT was performed at baseline and at monthly intervals for induction therapy. Injections were given monthly until no improvement was observed between successive OCTs. In the maintenance period, reinjections were performed for any recurrence of macular fluid on OCT. Main outcome measures were visual acuity and number of injections given. Twenty-five eyes of 22 patients with mean follow-up of 16 months [standard deviation (SD) = 3.7 months] had mean improvement of 1.6 lines of Snellen visual acuity (SD 2.9, 95% confidence interval 0.48–2.9, P = 0.008). Visual acuity was stable (≤3 lines of visual acuity lost) in 22 eyes (88%). Nine eyes (36%) gained ≥3 lines. Three eyes (12%) lost ≥3 lines. A mean of 6.0 (SD 2.7) injections were given over a follow-up period ranging from 8 to 21 months. We conclude that OCT-based intravitreal ranibizumab treatment for neovascular AMD offered excellent visual acuity results and reduced the number of injections compared with monthly dosing.