Owing to the development of optoelectronic and digital technology, the optical imaging of surgical microscopes has resulted in continuous innovation and progress in imaging quality, increased functions, and expanded application fields; thus, the related operations have improved. Compared with binocular surgery microscopes, video microscopes can provide multi-user video sharing as well as high-definition and intelligent images of surgery; furthermore, they are more ergonomic, thereby reducing fatigue among doctors. Based on the existing video-based surgical microscope, this paper presents the development and research status of the current video-based surgical-microscope optical imaging. First, the development pertaining to the optical imaging technology of surgical microscopes is introduced. Subsequently, to present the research status of the optical imaging of video hand microscopes, we discuss continuous zoom technology, multimode fusion imaging technology, such as fluorescence, multispectral, polarization, and photoacoustic imaging, and the development of optical imaging, digitization, and intelligentization. Finally, the future development trends are discussed.