BACKGROUND: Extended reality (XR) simulators, including virtual reality and augmented reality, hold significant promise for enhancing surgical training by providing trainees with a controlled practice environment. This is particularly vital in microsurgery, where the steep learning curve and the challenge of mastering surgical skills are significant. Despite notable advancements in XR technology, its role in ophthalmic surgical training remains uncertain. METHODS: In our systematic review and meta-analysis, eight electronic databases were searched, and studies were evaluated against predefined criteria. Data extraction and random-effects meta-analysis assessed the odds ratio (OR) for posterior capsular rupture (PCR), an important surgical complication. RESULTS: A meta-analysis of 17,623 eyes that underwent cataract surgery across seven studies revealed a significant decrease in PCR post-Eyesi practice, with low heterogeneity across studies (OR = 0.71, 95% CI = 0.60-0.85, I = 9%). Studies that predominantly utilized XR for cataract surgery training (84%) consistently improved surgical outcomes by reducing complications such as PCR, retained lens material, and aphakia. XR training also significantly improved operating scores (p < 0.05), self-efficacy (p < 0.01), and non-dominant hand dexterity (p < 0.01). Of the 25 studies in this review, 22 (88%) found overall XR training benefits. CONCLUSIONS: XR simulators enhance ophthalmic surgical training by reducing complications like PCR, and improving surgical performance, self-efficacy, and non-dominant hand dexterity. These findings challenge conventional training methods and advocate for integrating XR into residency curricula to optimize learning and patient outcomes.