Introduction:　The　aim　of　the　study　was　to　investigate　the　correlation　between　systemic　inflammation　biomarkers　and　morphological　changes　of　retinal　neurovascular　unit　(RNVU)　under　optical　coherence　tomography　(OCT)　and　OCT　angiography　(OCTA)　in　type　2　diabetic　patients　with　early　signs　of　diabetic　retinopathy　(DR).　Methods:　This　cross-sectional　study　was　carried　out　among　93　type　2　diabetic　patients　with　early　signs　of　DR　(170　eyes),　ranging　from　level　10　to　level　35　based　on　ETDRS　DR　severity　scale　score.　Age-,　sex-,　and　axial　length-matched　normal　subjects　were　enrolled　as　controls.　Systemic　inflammation　biomarkers　including　neutrophil-to-lymphocyte　ratio　(NLR),　monocyte-to-lymphocyte　ratio　(MLR),　and　systemic　immune-inflammatory　index　(SII)　were　calculated　based　on　peripheral　blood　results.　Retinal　neuronal　changes　of　RNVU　were　identified　by　accessing　the　thickness　of　macular　retinal　nerve　fiber　layer　(RNFL)　and　ganglion　cell　layer　(GCL)　using　OCT.　Retinal　microvascular　alterations　of　RNVU　were　evaluated　by　measuring　macular　vessel　density　(VD)　and　size　of　foveal　avascular　zone　(FAZ)　using　OCTA.　Results:　GCL　thickness　was　significantly　correlated　with　NLR　(r　=　-0.183,　p　=　0.017)　and　MLR　(r　=　-0.235,　p　=　0.002),　RNFL　thickness　was　significantly　associated　with　MLR　(r　=　-0.210,　p　=　0.008),　FAZp　was　positively　correlated　with　NLR　(r　=　0.153,　p　=　0.046)　and　MLR　(r　=　0.187,　p　=　0.014),　FAZa　was　positively　correlated　with　MLR　(r　=　0.189,　p　=　0.014),　and　VD　was　significantly　correlated　with　NLR　(r　=　-0.188,　p　=　0.014)　on　spearman　correlation　analysis.　Additionally,　VD　was　independently　associated　with　SII　in　both　univariable　and　multivariable　GLM　analysis　(p　＜　0.05).　This　difference　still　remained　statistically　significant　during　subgroup　analysis　after　controlling　DM　duration.　Conclusion:　Systemic　inflammation　biomarkers　including　NLR,　MLR,　and　SII　are　significantly　associated　with　not　only　retinal　microvascular　alterations　but　also　retinal　neuronal　changes,　providing　evidence　that　systemic　inflammation　may　play　a　crucial　role　on　the　early　morphological　changes　of　RNVU　and　early　DR　pathogenesis.　SII　is　independently　associated　with　VD,　which　supports　SII　may　serve　as　a　potential　biomarker　for　monitoring　early　microvascular　changes　of　DR.