Aim To evaluate the effectiveness of vitreous surgery with direct central retinal artery massage for the treatment of central retinal artery occlusion (CRAO). Methods Vitreous surgery with direct central retinal artery massage was performed on 10 consecutive patients with acute CRAO. After standard 3 port pars plana vitrectomy, a specially designed probe was used to massage the central retinal artery on the optic nerve head or within the optic nerve or both. The best-corrected visual acuity was measured and fundus photograph was taken before operation, at 24, 48 h and weekly intervals for at least 1 month postoperatively. Results Circulation was restored immediately during the operation in four cases, gradually since the first day after operation in four cases. There was no change in the remaining two cases, among which, central retinal vein occlusion occurred in one case 5 days later. No other complications occurred. At 2 months postoperatively, visual acuity had improved for three or more lines in six cases (60%), and remained the same in the rest of the cases. Conclusions Vitreous surgery with direct central retinal artery massage seems to be an effective and relatively safe treatment for CRAO.