Aflibercept and brolucizumab, two anti-VEGF agents used as intravitreal injections in ophthalmology, differ significantly in molecular weight (aflibercept—115 kDa and brolucizumab—26 kDa). Using aqueous humor samples collected after drug administration, we measured and performed a comparative analysis of pharmacokinetics and half-lives of these drugs in the human eye. Since the quantification of monoclonal antibodies (mAbs) using antigen–antibody reactions, such as ELISA, is influenced by endogenous ligands or anti-drug antibodies, we employed nano-surface and molecular-orientation limited proteolysis (nSMOL), combined with liquid chromatography–tandem mass spectrometry (LC-MS/MS), for accurate measurements. Aqueous humor samples were collected from 59 eyes of 59 patients treated with aflibercept and 52 eyes of 52 patients treated with brolucizumab. Samples were obtained with a median post-injection period of 30 (range, 2–49) days for aflibercept and 28 (range, 4–60) days for brolucizumab. A population pharmacokinetic (PPK) analysis revealed that the half-life of aflibercept in human aqueous humor was significantly shorter than that of brolucizumab, 2.88 days versus 9.00 days, respectively (p = 1.16 × 10⁻⁷). Using the same mass spectrometry conditions, we calculated the half-lives of the two drugs. These results may be useful for optimizing the efficacy of these drugs in clinical practice.

Kosuke Nagaoka, MD, Shinji Makino, MD, PhD; Acute multifocal placoid pigment epitheliopathy following administration of the first dose of the BNT162B2 COVID-19

Anterior communicating artery (ACA) aneurysm is the most common type of intracranial aneurysm, accounting for about 30% of all cerebral aneurysms [1]. Causes of visual deterioration and visual field defects induced by an intracranial aneurysm can generally be classified into optic nerve compression by the aneurysm, Terson syndrome, direct encephalopathy due to bleeding and hematoma from the ruptured aneurysm, and ischemia of the optic nerve due to vasospasm. Development of a superior altitudinal visual field defect after rupture of an ACA aneurysm seems to be extremely rare and is presumably due to ischemic optic neuropathy caused by vasospasm after subarachnoid hemorrhage (SAH) [2], [3], [4]. Here, we report a case of superior altitudinal visual field defect and optic disc atrophy associated with SAH following rupture of an ACA aneurysm. Received: 21 December 2020 Accepted: 30 January 2021 Publication Date: 17 March 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Massive subretinal hemorrhage secondary to neovascular age–related macular degeneration (nAMD) is relatively uncommon, and reports of secondary angle closure glaucoma associated with such hemorrhage are even rarer. We report a case of a 93‐year‐old woman with a history of nAMD who developed this condition, along with a review of the relevant literature.