Refractory macular hole (MH) includes large MH, traumatic MH, secondary MH, high myopic MH, unclosed MH and reopening MH.Refractory macular hole (MH) still has low anatomical closure rate and poor recovery of visual acuity after treatment of the current gold standard of pars plana vitrectomy (PPV), induction of posterior vitreous detachment, internal limiting membrane peeling and gas tamponade.Current surgical treatments include extended internal limiting membrane peeling, inverted internal limiting membrane flap, autologous internal limiting membrane transplantation, lens capsular transplantation, autologous neurosensory retinal transplantation, mesenchymal stem cells or exocrine transplantation and vitreous replacement.Stem cells or exocrine transplantation, the application of new long-acting vitreous replacement and the improvement of surgical techniques can promote the in situ healing of macular hole, which is a promising future.At present, the goal of all surgical methods is to induce or help stimulate glial tissue proliferation to enhance MH contraction and repair.Targeted individualized treatment according to the existing evidence-based medical evidence is a future trend.This article reviewed the researches on the treatment of refractory MH in recent years, in order to improve clinician' understanding of refractory MH and provide reference for optimizing and standardizing the treatment scheme.