{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T18:23:59Z","timestamp":1781115839959,"version":"3.54.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kangwon National University Hospital in 2023","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>This study aimed to investigate changes in dry eye disease (DED) parameters and tear film lipid layer distribution after intensive pulse light (IPL) combined with meibomian gland expression (MGX) in patients with meibomian gland dysfunction (MGD).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective study included 218 patients diagnosed with MGD who underwent IPL combined with MGX. Various DED parameters, including tear film lipid layer thickness (LLT), were measured using a Placido disc tear film analyzer and slit lamp. Inferior corneal images were quantified and divided into upper, lower, nasal, and temporal quadrants, with further subdivision into six parts from top to bottom using Python.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The ocular surface disease index, meibomian gland expressibility, and quality scores significantly improved after three treatment sessions. Slit-lamp-measured DED parameters also improved, excluding the fluorescein-stained tear meniscus height. Redness in the nasal limbal and bulbar conjunctivae significantly decreased. The mean LLT tended to increase after treatment. LLT in the upper half of the images, but not in the lower half, increased significantly, with the difference in LLT between the two halves decreasing significantly from 34.46 \u00b1\u2009 15.73 to 30.27 \u00b1\u2009 14.63\u2009nm (p =\u2009 0.031). When the vertical distribution was analyzed by further subdivision into six equal parts from top to bottom, the average difference in LLT decreased in the uppermost segment after treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>IPL combined with MGX reduced the vertical distribution of lipids in patients with MGD by reducing lower tear film lipid layer stasis. Thus, the Placido disc tear film analyzer is a useful tool for analyzing lipid layer distribution in MGD.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316935","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T18:27:41Z","timestamp":1740767261000},"page":"e0316935","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in the distribution of the tear film lipid layer after intensive pulsed light combined with meibomian gland expression in patients with meibomian gland dysfunction"],"prefix":"10.1371","volume":"20","author":[{"given":"Yongwoo","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Woo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Kyu","family":"Yun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Young","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3453-3505","authenticated-orcid":true,"given":"Chul Young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"issue":"3","key":"pone.0316935.ref001","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II epidemiology report","volume":"15","author":"F Stapleton","year":"2017","journal-title":"Ocul Surf"},{"issue":"3","key":"pone.0316935.ref002","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II definition and classification report","volume":"15","author":"JP Craig","year":"2017","journal-title":"Ocul Surf"},{"issue":"4","key":"pone.0316935.ref003","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1007\/s10103-021-03482-z","article-title":"Effect of intense pulsed light using acne filter on eyelid margin telangiectasia in moderate-to-severe meibomian gland dysfunction","volume":"37","author":"JY Han","year":"2022","journal-title":"Lasers Med Sci"},{"issue":"1","key":"pone.0316935.ref004","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00417-020-04834-1","article-title":"Intense pulsed light for meibomian gland dysfunction: a systematic review and meta-analysis","volume":"259","author":"X Leng","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"pone.0316935.ref005","first-page":"3684963","article-title":"Therapeutic Effect of Intense Pulsed Light (IPL) Combined with Meibomian Gland Expression (MGX) on Meibomian Gland Dysfunction (MGD)","author":"S Wei","year":"2020","journal-title":"J Ophthalmol"},{"issue":"3","key":"pone.0316935.ref006","first-page":"CD013559","article-title":"Intense pulsed light (IPL) therapy for the treatment of meibomian gland dysfunction","volume":"3","author":"S Cote","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"pone.0316935.ref007","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1007\/s00417-020-05044-5","article-title":"Characteristics of dry eye patients with thick tear film lipid layers evaluated by a LipiView II interferometer","volume":"259","author":"Y Lee","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"6","key":"pone.0316935.ref008","article-title":"Determination of tear lipid film thickness based on a reflected placido disk tear film analyzer","volume":"10","author":"PI Fu","year":"2020","journal-title":"Diagnostics (Basel)"},{"issue":"4","key":"pone.0316935.ref009","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1167\/iovs.10-6997a","article-title":"The international workshop on meibomian gland dysfunction: executive summary","volume":"52","author":"KK Nichols","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"6","key":"pone.0316935.ref010","doi-asserted-by":"crossref","first-page":"e0270268","DOI":"10.1371\/journal.pone.0270268","article-title":"Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study","volume":"17","author":"R Toyos","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pone.0316935.ref011","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s12938-017-0426-8","article-title":"Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation","volume":"16","author":"H Hwang","year":"2017","journal-title":"Biomed Eng Online"},{"issue":"4","key":"pone.0316935.ref012","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.jtos.2020.06.002","article-title":"Intense pulsed light treatment in meibomian gland dysfunction: A concise review","volume":"18","author":"B Tashbayev","year":"2020","journal-title":"Ocul Surf"},{"issue":"1","key":"pone.0316935.ref013","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jtos.2018.11.004","article-title":"Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction","volume":"17","author":"R Arita","year":"2019","journal-title":"Ocul Surf"},{"issue":"7","key":"pone.0316935.ref014","first-page":"1086","article-title":"Combination treatment of intense pulsed light therapy and meibomian gland expression for evaporative dry eye","volume":"12","author":"KL Peng","year":"2022","journal-title":"Life (Basel)"},{"issue":"7","key":"pone.0316935.ref015","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/ICO.0b013e318191b870","article-title":"The relationship between dry eye symptoms and lipid layer thickness","volume":"28","author":"CA Blackie","year":"2009","journal-title":"Cornea"},{"issue":"1","key":"pone.0316935.ref016","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/ICO.0000000000002101","article-title":"Mapping the Lipid Layer of the Human Tear Film","volume":"39","author":"Y Cohen","year":"2020","journal-title":"Cornea"},{"issue":"2","key":"pone.0316935.ref017","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/ICO.0000000000001101","article-title":"Automated measurement of tear film dynamics and lipid layer thickness for assessment of non-sjogren dry eye syndrome with meibomian gland dysfunction","volume":"36","author":"YW Ji","year":"2017","journal-title":"Cornea"},{"issue":"1","key":"pone.0316935.ref018","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.jtos.2017.09.002","article-title":"Post-blink tear film dynamics in healthy and dry eyes during spontaneous blinking","volume":"16","author":"DH Szczesna-Iskander","year":"2018","journal-title":"Ocul Surf"},{"issue":"2","key":"pone.0316935.ref019","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1001\/archopht.121.2.173","article-title":"Differentiation of lipid tear deficiency dry eye by kinetic analysis of tear interference images","volume":"121","author":"E Goto","year":"2003","journal-title":"Arch Ophthalmol"},{"issue":"12","key":"pone.0316935.ref020","doi-asserted-by":"crossref","first-page":"7417","DOI":"10.1167\/iovs.13-12916","article-title":"A comparison of patient matched meibum and tear lipidomes","volume":"54","author":"SH Brown","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"pone.0316935.ref021","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.bpj.2021.12.033","article-title":"Biophysical properties of tear film lipid layer I. Surface tension and surface rheology","volume":"121","author":"X Xu","year":"2022","journal-title":"Biophys J"},{"issue":"6","key":"pone.0316935.ref022","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.preteyeres.2009.07.002","article-title":"The Meibomian puzzle: combining pieces together","volume":"28","author":"IA Butovich","year":"2009","journal-title":"Prog Retin Eye Res"},{"issue":"2","key":"pone.0316935.ref023","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jtos.2018.12.006","article-title":"Clinical signs of meibomian gland dysfunction (MGD) are associated with changes in meibum sphingolipid composition","volume":"17","author":"V Paranjpe","year":"2019","journal-title":"Ocul Surf"},{"issue":"8","key":"pone.0316935.ref024","doi-asserted-by":"crossref","first-page":"4403","DOI":"10.1167\/iovs.14-16254","article-title":"Meibum color and free fatty acid composition in patients with meibomian gland dysfunction","volume":"56","author":"R Arita","year":"2015","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"1","key":"pone.0316935.ref025","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1475-1313.2007.00534.x","article-title":"Limbal and bulbar hyperaemia in normal eyes","volume":"28","author":"H Pult","year":"2008","journal-title":"Ophthalmic Physiol Opt"},{"issue":"4","key":"pone.0316935.ref026","doi-asserted-by":"crossref","first-page":"101499","DOI":"10.1016\/j.clae.2021.101499","article-title":"Tear film interferometry assessment after intense pulsed light in dry eye disease: A randomized, single masked, sham-controlled study","volume":"45","author":"Y Song","year":"2022","journal-title":"Cont Lens Anterior Eye"},{"issue":"1","key":"pone.0316935.ref027","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/jovr.jovr_12_18","article-title":"Effect of intense pulsed light therapy on tear proteins and lipids in meibomian gland dysfunction","volume":"14","author":"SA Ahmed","year":"2019","journal-title":"J Ophthalmic Vis Res"},{"key":"pone.0316935.ref028","doi-asserted-by":"crossref","first-page":"827544","DOI":"10.3389\/fneur.2022.827544","article-title":"Lipidomics profiles revealed alterations in patients with meibomian gland dysfunction after exposure to intense pulsed light","volume":"13","author":"H Zhao","year":"2022","journal-title":"Front Neurol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316935","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T18:28:02Z","timestamp":1740767282000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316935"}},"subtitle":[],"editor":[{"given":"Kofi","family":"Asiedu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,28]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316935","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,28]]}}}