LINCOFF RULES ARE NOT FOLLOWED IN RETINAL DETACHMENT WITH POSTERIOR BREAKS AND ATTACHED CORTICAL VITREOUS Shorya V. Azad, MS,* Brijesh Takkar, MD,* Indrish Bhatia, MS,* Rajvardhan Azad, MD† Purpose: 1) To evaluate factors governing flow of subretinal fluid and validate Lincoff rules (LRs) in cases of rhegmatogenous retinal detachment. 2) To identify cases of rhegmatogenous retinal detachment where LRs are not followed. Method: This was a retrospective study where 253 patients of rhegmatogenous retinal detachment were identified through surgery records. Two hundred and twenty-nine case sheets with complete record of ocular examination and surgical findings were analyzed. Seventy-five of the 229 patients, having subtotal rhegmatogenous retinal detachment where LR could be applied were included for analysis. Validity of LR was analyzed about location of break, lattice degeneration, posterior vitreous detachment (PVD), proliferative vitreoretinopathy, lens status, myopia, and trauma. Result: The mean age of the patients was 40.12 years. Sixty-one were men. Lincoff rule was validated in 59 of the 75 patients. Anterior breaks (P , 0.008) and PVD (P , 0.001) were found to have a significant association with validity of LR. Other attributes did not have a statistically significant association with validity of LR. Conclusion: Presence of posterior retinal breaks and absent PVD is associated with unusual flow of subretinal fluid. Lincoff rules are valid in most of the clinical scenarios. RETINAL CASES & BRIEF REPORTS 0:1–4, 2017 From the *Vitreo Retina Services, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India; and †Bharti Eye Hospital, New Delhi, India. R ules defined by Lincoff and Gieser 1 in 1971 for localizing retinal breaks on the basis of configu- ration of retinal detachment have guided the retinal surgeon successfully and are among the basic essentials. These rules, known as Lincoff rules (LRs), depend on factors affecting the flow of subretinal fluid, location of break, anatomical limits, and gravity. Although, these rules were evaluated in phakic patients with subtotal rhegmatogenous retinal detachments (RRDs) initially at a time when cataract surgery and intraocular implants were in evolution, their applicability was later stressed for pseudophakic patients as well, 2,3 although no studies have explored or confirmed the aforementioned dictums. Yet one rarely encounters scenarios where causative retinal breaks are found at unexpected locations. This study identifies various clinical situations affecting the flow of subretinal fluid, thus validating these rules across all types of RDs. We also analyze the cases where LRs are not followed, and in doing so discuss the possible interactions between the clinical attributes of RD that govern its configuration. Methods This study was in accordance with the Declarations of Helsinki, and informed written consent had been taken from the patients where ever relevant. Two hundred None of the authors has any financial/conflicting interests to disclose. Reprint requests: Brijesh Takkar, MD, Vitreo Retina Services, Dr RP Centre, AIIMS, New Delhi 110029, India; e-mail: britak. aiims@gmail.com 1 Copyright ª by Ophthalmic Communications Society, Inc. Unauthorized reproduction of this article is prohibited.