Damage of retinal microvasculature caused by accumulation of end products of an abnormal glucose metabolism (aldose reductase pathway). In this pathway, glucose is converted to Sorbitol whose accumulation in the pericytes of retinal blood vessels, causes weakness of the blood capillaries making them to out pouch easily forming aneurisms. Micro aneurisms may rupture causing hemorrhage into vitreous. Accumulation of sorbitol may cause occlusion of some of the blood vessels and hence causing retinal ischemia.

Neovascularization triggered by retinal ischemia which stimulates production of vasoproliferative factors . The newly formed blood vessels are fragile and hence they can rupture easily causing hemorrhage.

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