Background: Diabetic retinopathy is a major cause of visual loss today, especially in diabetic patients having disturbances in hemostasis. Plasma plasminogen activator inhibitor-1 (PAI-1) and lipoprotein (a) may be involved in the pathogenesis of diabetic retinopathy of type 2 diabetes mellitus. This study was undertaken to determine whether plasma PAI-1 and Lp(a) levels are increased in type 2 diabetic patients with retinopathy, and to identify factors influencing PAI-1 and Lp(a) levels. Methods: A total of 177 type 2 diabetic subjects were classified by the presence or absence of retinopathy, 92 and 85, respectively, and fasting blood samples were taken for assay of PAI-1, Lp(a), creatinine clearance, serum lipid profiles and C-peptide levels. Results: Subjects with retinopathy showed higher levels of PAI-1 (p<0.05), Lp(a) (p<0.01), total cholesterol (p<0.01), triglyceride (p<0.01) and longer disease duration than those without retinopathy. In multiple regression analysis, PAI-1 levels were significantly correlated with high density lipoprotein (HDL) cholesterol, while Lp(a) levels were correlated with body mass index, total cholesterol and low density lipoprotein (LDL) cholesterol. Conclusion: These results suggest that elevated PAI-1and Lp(a) are associated with the presence of diabetic retinopathy.