The proportion, clinical characteristics, and risk factors of zonulopathy in Primary Angle Closure Disease (PACD) were analyzed. Zonulopathy is an under-recognized common finding in PACD, especially in acute angle closure patients.To examine the proportion and risk factors associated with intraoperative zonulopathy in primary angle closure disease (PACD).This is a retrospective analysis of 88 consecutive PACD patients who underwent bilateral cataract extraction at Beijing Tongren Hospital from August 1, 2020 to August 1, 2022. Zonulopathy was diagnosed based on intraoperative findings including the presence of lens equator, radial folds of the anterior capsule while making capsulorhexis, and other signs of unstable capsular bag. The subjects were grouped based on their PACD subtype diagnoses: acute angle closure (AAC), primary angle closure glaucoma (PACG), primary angle closure (PAC), or primary angle closure suspect (PACS). Multivariate logistic regression was performed to identify risk factors associated with zonulopathy. The proportion and the risk factors of zonulopathy were estimated in PACD patients and in PACD subtypes.Of 88 PACD patients (67.3±6.9 y old, 19 male, 69 female), the overall proportion of zonulopathy was 45.5% of patients (40/88) and 30.1% of eyes (53/176). Among the PACD subtypes, the proportion of zonulopathy was highest (69.0%) in AAC, followed by 39.1% in PACG, and 15.3% in PAC and PACS combined. AAC was an independent risk factor associated with zonulopathy (P= 0.015, AAC vs PACG, PAC and PACS combined, OR 0.340, CI 0.142-0.814). Shallower anterior chamber depth (P=0.031) and greater lens thickness (P= 0.036), but not laser iridotomy, were associated with increased proportion of zonulopathy.Zonulopathy is common in PACD, especially in AAC patients. Shallow ACD and thick LT were associated with increased proportion of zonulopathy.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.