Diabetic retinopathy (DR) is one of the most serious microvascular complications of diabetes and a leading cause of visual impairment and blindness. In recent years, the role of intestinal and ocular microecology in DR has received increasing attention. Diabetic patients often present with dysbiosis of the intestinal flora, which is characterized by a decrease in anti-inflammatory bacteria, an increase in pro-inflammatory bacteria and a decrease in diversity, and may be involved in the progression of DR through inflammation and metabolic abnormalities. Localized flora changes in the eye may also be associated with DR. Animal experiments have shown that probiotics, prebiotics and fecal transplants have potential in improving flora, stabilizing blood glucose and attenuating retinopathy, but clinical applications need further validation. In the future, it is necessary to combine with multi-omics technology to study the function of bacterial flora in depth and explore novel therapeutic strategies, so as to provide new ideas for the prevention and treatment of DR.