Today’s patient presentation has Fuchs’ Corneal Dystrophy, a visually significant nuclear sclerotic cataract, an elevated Salzmann’s Nodule, and only has one eye. Each monocular patient, having only one eye, requires special consideration in preparation for eye surgery in terms of surgical options, timing, limitations, benefits, risk analysis, emotional support, postoperative care, and also the process of informed choice and consent. I feel fortunate to have operated on over 500 patients considered “monocular” and consider it a privilege to be able to walk these patients through the additional education and decision-making process that is required. My dear patient who has lost vision in her only useful eye due to a cataract and also Fuchs’ Corneal Dystrophy has worked up the nerve to undergo surgery. Cataract surgery alone would result in further corneal decompensation so we decided to proceed with combining cataract surgery with corneal transplantation under topical anesthesia using the safest available technique for endothelial keratoplasty (DSEK,DSAEK). She was openly and deservedly concerned and nervous since she was about to undergo surgery in her only eye. We approached her care as though she were a close relative or member of the surgical team having surgery and successfully performed the cataract surgery with intraocular lens insertion in combination with Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) which allows a “closed system” transplantation of corneal endothelial cells. On her first postoperative day (yesterday) she was 100% attached and already showing signs of great progress!