Abstract:  Angle closure glaucoma (ACG) secondary to lens subluxation is a clinical problem with complex etiology. Its essential anatomic change in its pathogenesis is zonulopathies caused by various reasons. Based on the anatomical characteristics and pathophysiological functions of zonule, this article reconceptualizes the adjacent tissue complex of the zonule, and proposes that the change of pressure between the adjacent tissue complex caused by zonulopathies is the key to understand the physiological process of ACG secondary to lens subluxation. Based on the pathogenesis of various types of lens subluxation and the pathophysiological process of complex pressure change, we can understand the ocular phenotype of zonulopathy and predict its possible surgical risks. Further, we propose four modular treatment methods to make apersonalized treatment for ACG secondary to lens subluxation, including the treatment of aqueous humor countercurrent, lens extraction, maintenance of long-term stability of intraocular lens and reconstruction of angle filtration, which provides guidance for the scientific treatment strategy of this kind of refractory glaucoma. (Ophthalmol CHN, 2023, 32: 363-368)

Key words: angle closure glaucoma secondary to lens subluxation, zonulopathies, surgery