This study presents a novel method to engineer exosomes with iron oxide nanoparticles (IONPs) using macrophages as a bioreactor. The resulting exosomes, named ESIONPs@EXO, exhibit multiple therapeutic properties, including magnetic imaging, ferroptosis induction, and immunotherapy. ESIONPs@EXO were shown to suppress pathological angiogenesis in vitro and in vivo without causing toxicity. Mechanistically, ESIONPs@EXO induce ferroptosis and exhibit immunotherapeutic abilities, making them a promising platform for targeted pathological angiogenesis therapy. The study demonstrates that a pure biological method to engineer ESIONPs@EXO using macrophages shows potential for treating conditions such as retinopathy and tumor angiogenesis.This study presents a novel method to engineer exosomes with iron oxide nanoparticles (IONPs) using macrophages as a bioreactor. The resulting exosomes, named ESIONPs@EXO, exhibit multiple therapeutic properties, including magnetic imaging, ferroptosis induction, and immunotherapy. ESIONPs@EXO were shown to suppress pathological angiogenesis in vitro and in vivo without causing toxicity. Mechanistically, ESIONPs@EXO induce ferroptosis and exhibit immunotherapeutic abilities, making them a promising platform for targeted pathological angiogenesis therapy. The study demonstrates that a pure biological method to engineer ESIONPs@EXO using macrophages shows potential for treating conditions such as retinopathy and tumor angiogenesis.