Diabetic retinal neurodegeneration (DRN) is a condition in which the normal function of retinal neurovascular units is impaired due to various factors such as oxidative stress, microvascular damage, metabolic disorders, neurotrophic factor imbalance, and immune damage in hyperglycemia environment. The loss of neurons and glial dysfunction is involved in the destruction of the blood-retinal barrier, impaired vascular response and neurovascular coupling, leading to microvascular disease and neurodegeneration. More and more studies have proved that DRN is associated with microangiopathy and diabetic retinopathy pathogenesis. A deeper understanding of the pathogenesis of neurovascular injury may provide new and more effective prevention strategies for diabetic retinopathy.