Diabetes is a group of metabolic diseases, considered a lifestyle disease. Diabetic retinopathy is the leading cause of blindness in working-age adults worldwide. Pathogenetically, due to the changed anionic charge, collagen gradually replaces glycosaminoglycans (GAG) in the basement membrane of retinal capillaries, affecting vascular permeability. Clinically, these changes cause leakage from the retinal capillaries, which leads to the development of microaneurysms and, consequently, the formation of hard effusions (HE). Sulodexide is a glycosaminoglycan containing 80% of small molecular weight, fast moving heparin fraction (FMH) and 20% of dermatan sulfate. An important target of sulodexide's action are vascular endothelial cells, and its protective effect is partially related to the preservation and reconstruction of the glycocalyx structure on the surface of the endothelial layer cells. Additionally, sulodexide has been documented to strengthen the glycocalyx of retinal arterioles in people with diabetes. These findings suggest that sulodexide holds promise as a potential therapeutic agent for the treatment of diabetic retinopathy.