Extended Reality Simulation Reduces Posterior Capsular Rupture In Cataract Surgery: A Systematic Review And Meta-Analysis

To evaluate the impact of extended reality (XR) simulators, including virtual and augmented reality platforms, on ophthalmic surgical performance and complication rates.

Systematic review and meta-analysis of studies assessing XR-based training in ophthalmic surgery.

Eight electronic databases were searched (January 2013–April 2023). Studies evaluating XR training for ophthalmic surgical skill acquisition were included. Primary outcome was posterior capsular rupture (PCR) during cataract surgery. Random-effects meta-analysis was performed to estimate pooled odds ratios (OR). Risk of bias was assessed using RoB 2 and ROBINS-I tools.

Twenty-five studies met inclusion criteria, including 17,623 eyes from seven studies eligible for meta-analysis. XR training was predominantly used for cataract surgery (92%), most commonly with the Eyesi simulator. Meta-analysis demonstrated a significant reduction in PCR among XR-trained surgeons compared with controls (OR 0.71, 95% CI 0.58–0.86; I² = 21%). Across studies, XR training was associated with improved operating scores, enhanced non-dominant hand dexterity, higher self-efficacy, and reduced operative time in selected cohorts. Overall, 88% of included studies reported beneficial effects of XR training.

XR simulation training is associated with reduced complication rates and improved surgical performance in ophthalmology, particularly in cataract surgery. These findings support integration of XR simulators into structured residency curricula to enhance surgical proficiency and patient safety.