Yang Lucy, Al-Ani Abdullah, Bondok Mohamed S, Gooi Patrick, Chung Helen
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, AB, Canada.
Eye (Lond). 2025 Feb 28. doi: 10.1038/s41433-025-03722-4.
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.
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.
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.
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.
扩展现实（XR）模拟器，包括虚拟现实和增强现实，通过为受训者提供可控的练习环境，在提升外科手术培训方面具有巨大潜力。这在显微手术中尤为重要，因为显微手术学习曲线陡峭，掌握手术技能面临巨大挑战。尽管XR技术取得了显著进展，但其在眼科手术培训中的作用仍不明确。
在我们的系统评价和荟萃分析中，检索了八个电子数据库，并根据预定义标准对研究进行评估。数据提取和随机效应荟萃分析评估了后囊破裂（PCR）这一重要手术并发症的比值比（OR）。
对七项研究中17,623只接受白内障手术的眼睛进行的荟萃分析显示，在使用Eyesi练习后，PCR显著减少，研究间异质性较低（OR = 0.71，95%CI = 0.60 - 0.85，I = 9%）。主要将XR用于白内障手术培训的研究（84%）通过减少PCR、残留晶状体物质和无晶状体等并发症，持续改善了手术结果。XR培训还显著提高了操作评分（p < 0.05）、自我效能感（p < 0.01）和非优势手的灵巧性（p < 0.01）。在本综述的25项研究中，22项（88%）发现了XR培训的总体益处。
XR模拟器通过减少PCR等并发症，提高手术表现、自我效能感和非优势手的灵巧性，从而增强眼科手术培训。这些发现挑战了传统培训方法，并主张将XR纳入住院医师课程，以优化学习效果和患者治疗结果。
