A clinical and histopathological study of an organized macular plaque in a diabetic with hard exudate plaques showed diabetic microangiopathy, degeneration, proliferation and serious separation of the pigment epithelium, but no evidence of disease of Bruch's membrane or the choriocapillaris. The possible absence of choroidal neovascularization suggests that the fibrous scar originated in the retina and pigment epithelium. This lesion may be a specific response to the development of a plaque of hard exudate at the macula.