Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM) and a leading cause of visual loss in working-age populations. It is a microvascular disease characterized by retinal vascular abnormalities, with two main stages: non-proliferative (NPDR) and proliferative (PDR) DR. NPDR involves increased vascular permeability and capillary occlusion, while PDR is marked by neovascularization and severe vision loss due to vitreous hemorrhage or retinal detachment. Diabetic macular edema (DME), a major cause of vision loss in DR, results from fluid accumulation in the macula due to breakdown of the blood-retinal barrier (BRB). Current treatments for DR include anti-VEGF therapy, laser photocoagulation, and vitreous surgery. Anti-VEGF agents, such as ranibizumab, aflibercept, and bevacizumab, are effective in improving visual acuity but have limitations, including frequent injections and potential adverse effects. Other treatments, such as intravitreal corticosteroids, have shown promise in refractory DME but are associated with significant side effects. Laser therapy remains an important adjuvant treatment, particularly in PDR. Newer therapies, including anti-inflammatory agents, novel anti-angiogenic drugs, and other pharmacological agents, are being investigated to improve outcomes. Research highlights the roles of inflammation, retinal neurodegeneration, and vascular pathology in DR pathogenesis, suggesting new therapeutic targets. Despite advances, further investigation is needed to develop more effective and safer treatments for DR.Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM) and a leading cause of visual loss in working-age populations. It is a microvascular disease characterized by retinal vascular abnormalities, with two main stages: non-proliferative (NPDR) and proliferative (PDR) DR. NPDR involves increased vascular permeability and capillary occlusion, while PDR is marked by neovascularization and severe vision loss due to vitreous hemorrhage or retinal detachment. Diabetic macular edema (DME), a major cause of vision loss in DR, results from fluid accumulation in the macula due to breakdown of the blood-retinal barrier (BRB). Current treatments for DR include anti-VEGF therapy, laser photocoagulation, and vitreous surgery. Anti-VEGF agents, such as ranibizumab, aflibercept, and bevacizumab, are effective in improving visual acuity but have limitations, including frequent injections and potential adverse effects. Other treatments, such as intravitreal corticosteroids, have shown promise in refractory DME but are associated with significant side effects. Laser therapy remains an important adjuvant treatment, particularly in PDR. Newer therapies, including anti-inflammatory agents, novel anti-angiogenic drugs, and other pharmacological agents, are being investigated to improve outcomes. Research highlights the roles of inflammation, retinal neurodegeneration, and vascular pathology in DR pathogenesis, suggesting new therapeutic targets. Despite advances, further investigation is needed to develop more effective and safer treatments for DR.