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Thrombomodulin is a glycoprotein located on the surface membrane of vascular endothelial cells. Recently the presence of thrombomodulin antigens was detected in circulating blood plasma. The thrombomodulin antigens are thought to have been released from injured endothelial cells, and thus plasma thrombomodulin has been attracting attention as a new molecular marker indicating injuries to vascular endothelial cells. We investigated plasma thrombomodulin levels in relation to the severity of diabetic retinopathy, and found that they increased as retinopathy progressed. The Mann-Whitney U test revealed significant differences between no retinopathy and proliferative retinopathy (p = 0.002), between simple retinopathy and proliferative retinopathy (p = 0.01), and between preproliferative retinopathy and proliferative retinopathy (p = 0.03). However, ocular vascular injuries may correlate with systemic vascular injuries. Therefore, the progress of retinopathy may be predicted by monitoring plasma thrombomodulin levels in selected patients.