Idiopathic maculae hole (IMH) is a full thickness vascular defect in the central fovea without specific underlying diseases. It is one of the most commonly encountered diseases in the surgical retinal field. The most common mechanism for the development of IMH is thought to involve the vitreo-macular separation with persistent vitreo foveal adhesion causing vitreo foveal traction and eventually foveal dehiscence. The standard treatment consists of vitrectomy, internals limiting membrane peeling and gas tamponade. In this presentation, an updated development in the pathogenesis, classification and treatment, especially to intractable cases will be discussed.