Abstract: With the growing demand for manufacturing high-end optical components in critical fields such as aerospace observation, laser fusion, and extreme ultraviolet lithography, the lack of industrialized applications of medium-to-large aperture ultra-precision optical grinding machines in China has become a significant bottleneck. The research status of ultra-precision grinding machines for medium-to-large aperture optical components is systematically reviewed, focusing on three core aspects, namely whole-machine structural design, key functional components, and process technology assurance. Key advancements in critical technologies are highlighted, including machine structures with high static and dynamic performance, hydrostatic bearing technology, grinding wheel truing and dressing, and on-machine measurement. Existing challenges in domestic research are identified, and countermeasures are proposed. The future development trends for medium-to-large aperture ultra-precision optical grinding machines are also discussed.