The purpose of this study was to summary the characteristics of ophthalmic artery (OphA) aneurysms and to obtain the independent risk factors for poor prognosis of microsurgical clipping treatment for OphA aneurysms. The clinical and microsurgical clipping results of all 63 patients with ophthalmic aneurysm were investigated and reviewed. The OphA aneurysm patient’s case records were reviewed including clinical characteristics, image findings, and clinical outcomes. Then, the risk factors of poor prognosis were analyzed retrospectively. Monocular blindness persisted in 4 patients (6.35%), 1 patient developed persistent vegetate state (PVS) (1.59%), while 4 patients (6.35%) died. The matching process constructed a cohort consisting of 9 poor outcome (Glasgow Outcome Scale, GOS 1-3) patients (14.3%), and 54 good outcome (GOS 4-5) patients (85.7%). Univariate analysis between the good outcome and poor outcome revealed statistical significance in age > 60 ( = 0.045), size ( = 0.016), and rupture before operation ( = 0.049). Further, multivariate logistic regression analysis identified age > 60 (odds ratio [OR], 5.877; 95% confidence interval [CI], 1.039-33.254; = 0.045) and aneurysm size > 10mm (OR, 9.417; 95% CI, 1.476-60.072; = 0.018) as the independent risk factors for poor outcome in microsurgical clipping treatment for OphA aneurysms. The significant independent risk factors associated with clipping OphA aneurysms are age (>60) and size (>10mm).