We examined the vitreous of 71 eyes with idiopathic preretinal macular fibrosis and observed complete posterior vitreous detachment in 48 eyes (68%), partial posterior vitreous detachment in 16 eyes (22%), and no posterior vitreous detachment in seven eyes (10%). Among the 48 eyes with posterior vitreous detachment, we observed that the detached posterior hyaloid membrane had an oval or round defect in 31 eyes (65%) and a break in the premacular area in 12 eyes (25%). The size and the contour of the premacular defects in the posterior hyaloid membrane corresponded to those characteristic of premacular fibrosis. A premacular oval defect in the detached posterior hyaloid membrane indicates that the vitreous cortex is a structural component of idiopathic premacular fibrosis. We postulate that the thin, premacular vitreous cortex, which forms the posterior wall of the premacular liquefied pocket, plays a key role in the development of idiopathic preretinal macular fibrosis in eyes with or without posterior vitreous detachment.