OBJECTIVES:   To evaluate and comparate the efficacy, safety and cost of the bevacizumab and ranibizumab intravitreous injections for the treatment of age related macular degeneration (AMD).   METHODS: A systematic review of literature was conducted. The bibliographic search covered the period between January 1996 and January 2011. The search was run on MEDLINE, EMBASE, Cochrane library, INAHTA and ECRI. The criteria employed to select the papers were: population (AMD patients), treatment (Ranibizumab or Bevacizumab), comparison (placebo or other active treatments). To assess the efficacy, it was decided to include systematic reviews and randomised clinical trials (RCT). For the safety, it was considered any type of study.   RESULTS: The bibliographical search retrieved 731 references of articles and 51 papers were finally included: 4 were controlled clinical trials: two on Ranibizumab and two on Bevacizumab. Efficacy: Ranibizumab and Bevacizumab, as compared to placebo as to Verteporfin, gets results in terms of AMD stabilization (between 0 and 1.2% of severe visual losses as opposed to 13-16% in the control groups), in terms of reduction in the lesion size and it even achieves improvement in visual acuity in some cases. Safety: The adverse effects (of any magnitude) were more frequent in the groups treated with Ranibizumab and Bevacizumab than in the control groups (placebo and Verteporfin). The data’s synthesis showed adverse effects similar in both drugs. Economic Evaluation: Drug costs for 1 year of treatment were estimated as 2.330€ for Ranibizumab and 53€ for Bevacizumab.     CONCLUSIONS: :Both drugs provide startling benefits in the treatment of age-related macular degeneration (AMD). Cost effectiveness analysis of bevacizumab makes this intervention highly cost effective versus ranibizumab. The price of ranibizumab would have to be drastically reduced for it to be cost effective. Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD.