I have previously featured a challenging cataract case for a patient with severe tremors due to systemic neurological disease. In that case, shown here, the patient had violent shaking every 15 seconds. I was still able to safely complete the case using just topical anesthesia and a little intra-venous midazolam. This video is similar and our guest surgeon does a great job in safely completing the case without general anesthesia. Some CataractCoach viewers will certainly suggest that using general anesthesia would be a better option, and in their hands, I will trust their judgment. But keep in mind that each of us, particularly experienced surgeons, know our own limitations and skillset and we always do what we believe is in the patient’s best interests. This video shows a beautiful surgery despite the patient titubations.