Abstract: The surgical concept for idiopathic macular holes has evolved from "relieving traction" to an individualized and precise era of "structural reconstruction". To enhance the hole closure rate and postoperative visual quality, various modified techniques of internal limiting membrane (ILM) peeling have emerged: expanded ILM peeling aims to completely relieve tangential traction, ILM peeling with preservation of the fovea is designed to minimize iatrogenic damage to the fovea, ILM inversion and coverage or filling (using autologous ILM or human Amniotic Membrane, hAM) provide mechanical support to actively promote hole healing and closure, flapless ILM transposition achieves coverage by horizontal transposition of a pedicled inner membrane flap. The core of modern surgical strategies lies in selecting the best technique based on the specific characteristics of the hole, with the ultimate goal of achieving high-level anatomical closure and maximizing the repair of photoreceptor microstructure, thereby significantly improving long-term visual quality for patients.

Key words: Idiopathic macular hole, Internal limiting membrane