AIM: To explore the effects of internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling in treatment of idiopathic macular hole(IMH)and the influence on macular structure and choroidal thickness.METHODS: Clinical data of patients with IMH who were treated in the hospital between January 2017 and December 2019 were retrospectively analyzed. All patients were treated with standard vitrectomy combined with internal limiting membrane stripping and gas-liquid exchange. On this basis, patients treated with internal limiting membrane transplantation(28 cases, 29 eyes), inverted internal limiting membrane flap(26 cases, 28 eyes)and autologous blood filling(25 cases, 25 eyes)were included in the internal limiting membrane transplantation group, inverted internal limiting membrane flap group and autologous blood filling group, respectively. The situation of hole closure and shape of the closed hole were observed. The best corrected visual acuity(BCVA), hole photoreceptors inner segment/outer segment ellipsoid zone(EZ)and external limiting membrane(ELM)defect diameter, perimeter of foveal avascular zone(PERIM), superficial capillary plexus(SCP)blood flow density, subfoveal choroidal thickness(SFCT), temporal choroidal thickness(TCT)and nasal choroidal thickness(NCT)were determined. RESULTS: All patients in the 3 groups successfully completed the surgery. The BCVA of internal limiting membrane transplantation group and inverted internal limiting membrane flap group was better than that of autologous blood filling group at 3mo after surgery(P0.05). However, there were significant differences in morphological classification of the closed macular hole(P0.05). CONCLUSION:Internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling can restore the closure of the macular hole. However, internal limiting membrane transplantation and inverted internal limiting membrane flap can better restore the macular structure and improve visual acuity, compared with autologous blood filling.