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Mesenchymal stem cells (MSCs) were extensively explored as new therapeutic agents in cell-based therapy due to their immunomodulatory and pro-angiogenic characteristics.Exosomes are nanovesicles surrounded by a phospholipid layer.Recent studies have demonstrated that MSCs-derived exosomes (MSCs-exo) and MSCs have similar functions.MSCs-exo are considered as an ideal treatment for multiple ocular diseases including uveitis, glaucoma, retinal and ocular surface diseases.However, with complex contents and diverse functions, exosomes need to be modified with different strategies to avoid rapid clearance by the immune system, reduce side effects, enhance target cell specificity, and improve intracellular delivery efficiency.After the modification of MSCs-exo contents, specific therapeutic factor could be overexpressed in MSCs-exo in order to maximize their therapeutic potential and efficacy for specific eye diseases, which is expected to be a new choice for the treatment of eye diseases.This paper focuses on the applications of MSCs-exo and the current researches of exosomes modification strategies, and discusses the potential application prospects of modified MSCs-exo in the treatment of eye disease.