We present the case of a 75-years-old male patient with decreased visual acuity from vitreous hemorrhage. Visual acuity was hand movement. We performed 23 G pars plana vitrectomy under topical anesthesia. The patient was very interested in all surgical procedures. We communicated with him during the surgery. The procedure was completed in approximately twenty minutes without any complications. In both the intraoperative and postoperative The Visual Analogue Pain Scale was 0 (no pain/discomfort). Two months later, visual acuity improved 20/25. Intraocular instruments positioned through the pars plana helped the surgeon steady the eye and prevent sudden eye movements since the presence of ocular motility during surgery may prove stressful for the surgeon specifically while performing macular procedures. Communication with patients is vital for the topical technique to be used successfully. It is apparent that various procedures, including the 23 G cannulas insertion and removal, endolaser application to the retina, premacular peeling, fluid-air exchange, can be performed without akinesia.