Central retinal vein occlusion is a common retinal disease with usually severe complications. At present no safe treatment exists promoting the recovery of lost vision. Several surgical approaches to modify the natural course of the disease have been proposed in recent years. These options include laser-induced chorioretinal venous anastomosis, the injection of tissue plasminogen activator into a retinal vein, optic nerve decompression, and vitrectomy for macular edema. Even though all the proposed treatments have not yet been supported by randomized clinical trials, these techniques can be considered as innovative in an area where no effective treatment is available. Larger clinical trials are required to assess both the effectiveness and complication rate of surgical treatments designed to reverse the natural evolution of central retinal vein occlusion.