Objective To investigate the association of lipoxins A4 (LXA4) and vascular endothelial growth factor (VEGF) with diabetic retinopathy (DR). Methods Ninety diabetic patients were divided into three groups, i.e. no diabetic retinopathy (NDR) group, simple diabetic retinopathy (SDR) group and proliferative diabetic retinopathy (PDR) group. And 40 normal persons were recruited as the control group. The serum levels of LXA4 and VEGF were examined, and relationship between LXA4 and VEGF was also investigated. Results The serum LXA4 levels in the NDR, SDR and PDR groups were lower than that in the control group (P = 0.000). The serum LXA4 levels in the PDR and SDR groups were lower than that in the NDR group (P < 0.05). The serum LXA4 level in the PDR group was lower than that in the SDR group (P < 0.05). There was no statistical difference in VEGF between the NDR and control groups (P > 0.05). The serum VEGF level was higher in the SDR and PDR groups than in the NDR and control groups (P = 0.001), and it was also higher in the PDR group than in the SDR group (P < 0.05). Serum LXA4 level was negatively correlated with VEGF level (P < 0.05). Conclusions Decreased LXA4 and increased VEGF levels in serum may be the risk factors of retinopathy in diabetic patients.