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Purpose: Plenty of factors including inflammation are responsible for development of diabetic retinopathy (DR). Epicardial fat produces adipokines, cytokines and inflammatory products. Monocyte count to high density lipoprotein (HDL) ratio (MHR) has been recently suggested as an inflammatory marker. Methods: Epicardial fat thickness (EFT) and MHR were analyzed in 36 diabetics without DR (NDR), 35 diabetics with proliferative DR (PDR) and 41 diabetics with nonproliferative DR patients (nonPDR). Results: Monocyte counts, HDL, mean MHR and EFT values of NDR, nonPDR and PDR groups were significantly different. One-way analysis of variance test with post hoc Tukey test revealed that the significance of differences in MHR and EFT were dependent on the differences between NDR and PDR (p<0.001 for both) and nonPDR and PDR groups (p<0.001 and p=0.001). The differences between NDR and nonPDR (p=0.81 and p=0.06) were not significant. MHR and EFT were significantly positively correlated with PDR (r=0.453, p<0.001 and r=0.394, p<0.001) and negatively correlated with NDR (r=−0.256, p=0.006 and r= −0.380, p<0.001). Only EFT was found to be independently associated with PDR (p=0.002, 95% CI: OR: 1.643 (1.206–2.237)). An EFT value of >5.90 mm classified the presence of PDR with a sensitivity 74% and specificity of 61% (AUC = 0.750, 95% CI, 0.658–0.843), and a MHR value of >12.8 ratio classified the presence of PDR with a sensitivity of 83% and a specificity of 79% (AUC = 0.811, 95% CI, 0.728–0.893). Conclusion: We suggest that MHR and EFT were significantly increased in proliferative DR, and increased EFT may predict the presence of PDR in type 2 DM. [ABSTRACT FROM AUTHOR]