This is a review article characterising a clinical entity called paracentral acute middle maculopathy (PAMM). The article highlights the fact that retinal capillary plexuses are organised predominantly into three trilaminar capillary layers occupying the area between the nerve fibre layer to the inner nuclear layer (INL). The failure of the blood flow through this vascular system can result in ischaemic lesions typically located at the INL in the form of hyperreflective bands on OCT. Patients typically present with acute onset paracentral scotoma and experience a permanent visual defect. The article highlights the difference between PAMM and acute macular neuro-retinopathy (AMN) in that AMN tends to have hyperreflective bands at the outer nuclear layer with associated ellipsoid zone changes.