As challenging cataract cases go, this one had it all. Mrs. V, a 5-foot-1, 341-pound, 67-year-old female with multiple co-morbid conditions, including hypertension, diabetes, obesity and sleep apnea, presented for surgery on her right eye. She uses nasal oxygen at 2 liters and ambulates with the aid of a walker, but with some difficulty. At bedtime, she needs at least two pillows and can't lie flat.